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Perinatal factors associated with long-term respiratory sequelae in extremely low birthweight infants
  1. Katsuya Hirata1,
  2. Masahiro Nishihara1,
  3. Jun Shiraishi1,
  4. Shinya Hirano1,
  5. Katsura Matsunami1,
  6. Kiyoaki Sumi1,
  7. Norihisa Wada1,
  8. Yutaka Kawamoto1,
  9. Masanori Nishikawa2,
  10. Masahiro Nakayama3,
  11. Tadahiro Kanazawa4,
  12. Hiroyuki Kitajima1,
  13. Masanori Fujimura1
  1. 1Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
  2. 2Department of Radiology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
  3. 3Clinical Laboratory Medicine and Anatomic Pathology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
  4. 4Department of Comparative and Developmental Psychology, Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan
  1. Correspondence to Dr Katsuya Hirata, Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan; khirata0513{at}gmail.com

Abstract

Objective To assess lung function at 8 years old in extremely low birthweight (ELBW) survivors and to identify perinatal determinants associated with impaired lung function.

Design Retrospective cohort study.

Setting Level III neonatal intensive care unit.

Patients ELBW survivors born in 1990–2004 with available spirometry at 8 years old were studied. Children were excluded if they had a Wechsler Intelligence Scale for Children Third Edition full IQ <70.

Main outcome measures Multivariate logistic regression analysis was used to identify perinatal determinants associated with airway obstruction (forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio <80%) at school age and the predictive power of potential determinants. Potential risk factors and predictors assessed in this study were gestational age, birth weight, small for gestational age, sex, chorioamnionitis, premature rupture of membranes, antenatal steroids, surfactant administration, respiratory distress syndrome, postnatal steroids, severe bronchopulmonary dysplasia and bubbly/cystic appearances of the lungs by X-ray during the neonatal period.

Results Of 656 ELBW survivors, 301 (45.9%) had attended a school-age follow-up at 8 years old. A total of 201 eligible children completed the lung function test. Bubbly/cystic appearance of the lungs (OR 4.84, 95% CI 1.26 to 18.70) was associated with a low FEV1/FVC ratio. Children with bubbly/cystic appearance had characteristics of immaturity and intrauterine inflammation.

Conclusions Within a cohort of ELBW infants, a bubbly/cystic appearance of the lungs in the neonatal period was the strongest determinant of a low FEV1/FVC ratio at school age.

  • Neonatology
  • Respiratory

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