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Intrauterine growth restriction predicts lower lung function at school age in children born very preterm
  1. Eveliina Ronkainen1,2,
  2. Teija Dunder3,
  3. Tuula Kaukola4,
  4. Riitta Marttila4,
  5. Mikko Hallman1,4
  1. 1PEDEGO Research Center, and Medical Research Center Oulu, University of Oulu, Oulu, Finland
  2. 2Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
  3. 3Division of Allergology and Pulmonology, Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
  4. 4Division of Neonatal Medicine, Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
  1. Correspondence to Dr Eveliina Ronkainen, Oulu University Hospital, Department of Children and Adolescents, P.O. Box 23, Oulu FIN-90029 OYS, Finland; eveliina.ronkainen{at}oulu.fi

Abstract

Objective Children born preterm have lower lung function compared with term-born children. Intrauterine growth restriction (IUGR) may predispose individuals to chronic obstructive pulmonary disease. The purpose of this observational study was to investigate the role of IUGR as predictor of lung function at school age in children born very preterm. We further studied the difference in lung function between term-born and preterm-born children with distinct morbidities.

Design Preterm-born children and age-matched and sex-matched term-born comparison groups (88 of each) were studied at the mean age of 11 years. Spirometry and diffusing capacity of the lung for carbon monoxide (DLCO) were recorded. All preterm-born subjects with IUGR (n=23), defined as birth weight less than −2 SD, were compared with preterm-born subjects without IUGR (n=65).

Results In the preterm-born children exposed to IUGR, the forced expiratory volume in 1 s (FEV1) was 5.7 (95% CI −10.2 to −1.3) and DLCO 9.2 percentage points lower (95% CI −15.7 to −2.7) than in the preterm-born children with appropriate in utero growth (expressed as percentage of predicted values). The effect of IUGR in decreasing FEV1 and DLCO remained significant after adjustment for bronchopulmonary dysplasia (BPD). Further study indicated that after adjustment with IUGR and BPD, prematurity explained reduction in FEV1 but not in DLCO.

Conclusions In children born very preterm, IUGR is an independent risk factor for a lower lung function in school age. We propose that IUGR and BPD are the major early factors predisposing the children born very preterm to lower lung function.

  • premature birth
  • bronchopulmonary dysplasia
  • intrauterine growth restriction
  • lung function test
  • pulmonary outcome

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