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Functional evidence for continued alveolarisation in former preterms at school age?


Yammine, Sophie; Schmidt, Anne; Sutter, Oliver; Fouzas, Sotirios; Singer, Florian; Frey, Urs; Latzin, Philipp (2016). Functional evidence for continued alveolarisation in former preterms at school age? European Respiratory Journal, 47:147-155.

Abstract

Prematurity is the most common disruptor of lung development. The aim of our study was to examine the function of the more vulnerable peripheral airways in former preterm children by multiplebreath washout (MBW) measurements. 86 school-aged children, born between 24 and 35 weeks of gestation and 49 term-born children performed nitrogen MBW. Lung clearance index (LCI), and slope III-derived Scond and Sacin were assessed as markers for global, convection-dependent and diffusion–convection-dependent ventilation inhomogeneity, respectively.
We analysed the data of 77 former preterm (mean (range) age 9.5 (7.2–12.8) years) and 46 term-born children (mean age 9.9 (6.0–15.9) years). LCI and Sacin did not differ between preterm and term-born children. Scond was significantly elevated in preterm compared to term-born participants (mean difference z-score 1.74, 95% CI 1.17–2.30; p<0.001), with 54% of former preterm children showing elevated Scond. In multivariable regression analysis Scond was significantly related only to gestational age (R2=0.37). Normal Sacin provides evidence for a functionally normal alveolar compartment, while elevated Scond indicates impaired function of more proximal conducting airways. Together, our findings support the concept of continued alveolarisation, albeit with “dysanaptic” lung growth in former preterm children.

Abstract

Prematurity is the most common disruptor of lung development. The aim of our study was to examine the function of the more vulnerable peripheral airways in former preterm children by multiplebreath washout (MBW) measurements. 86 school-aged children, born between 24 and 35 weeks of gestation and 49 term-born children performed nitrogen MBW. Lung clearance index (LCI), and slope III-derived Scond and Sacin were assessed as markers for global, convection-dependent and diffusion–convection-dependent ventilation inhomogeneity, respectively.
We analysed the data of 77 former preterm (mean (range) age 9.5 (7.2–12.8) years) and 46 term-born children (mean age 9.9 (6.0–15.9) years). LCI and Sacin did not differ between preterm and term-born children. Scond was significantly elevated in preterm compared to term-born participants (mean difference z-score 1.74, 95% CI 1.17–2.30; p<0.001), with 54% of former preterm children showing elevated Scond. In multivariable regression analysis Scond was significantly related only to gestational age (R2=0.37). Normal Sacin provides evidence for a functionally normal alveolar compartment, while elevated Scond indicates impaired function of more proximal conducting airways. Together, our findings support the concept of continued alveolarisation, albeit with “dysanaptic” lung growth in former preterm children.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Children's Hospital Zurich > Medical Clinic
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:October 2016
Deposited On:11 Nov 2015 13:14
Last Modified:02 Feb 2018 09:37
Publisher:European Respiratory Society
ISSN:0903-1936
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1183/13993003.00478-2015
PubMed ID:26493788

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