Respiratory and Cardiovascular Outcomes in Survivors of Extremely Preterm Birth at 19 Years

Abstract

Rationale: Growth and development during adolescence may modify the respiratory and vascular differences seen among extremely preterm (EP) individuals in childhood and early adolescence.Objectives: To assess the trajectory of respiratory and cardiovascular outcomes during transition to adulthood in a national longitudinal cohort study of births before 26 weeks of gestation in the United Kingdom and Ireland.Methods: A total of 129 EP participants and 65 control subjects attended for a center-based evaluation at 19 years of age. Standardized measures of spirometry, hemodynamics, functional capacity, and markers of inflammation were obtained from EP subjects with and without neonatal bronchopulmonary dysplasia and term-born control subjects at 19 years of age and compared with previous assessments.Measurements and Main Results: Compared with the control group, the EP group was significantly impaired on all spirometric parameters (mean FEV₁z-score, -1.08 SD [95% confidence interval, -1.40 to -0.77]) and had lower fractional exhaled nitric oxide concentrations (13.9 vs. 24.4 ppb; P < 0.001) despite a higher proportion with bronchodilator reversibility (27% vs. 6%). The EP group had significantly impaired exercise capacity. All respiratory parameters were worse after neonatal bronchopulmonary dysplasia, and respiratory function differences were similar at 11 and 19 years. The augmentation index was 6% higher in the EP group and associated with increased total peripheral resistance (difference in means, 96.4 [95% confidence interval, 26.6-166.2] dyne/s/cm^-5) and elevation in central, but not peripheral, blood pressure. Central systolic and diastolic blood pressures increased more quickly during adolescence in the EP group than in the control group.Conclusions: Clinicians should address both cardiovascular and respiratory risks in adult survivors of extremely preterm birth.

Keywords: adult outcomes; cardiovascular function; extreme prematurity; lung function.

Figure 1.

(Left panel) FEV₁ z-score before and (right panel) percent change after bronchodilator in term-born control subjects and extremely preterm (EP) participants (with and without neonatal bronchopulmonary dysplasia [BPD]) at 19 years of age.

Figure 2.

Trajectory of FEV₁ and cardiovascular parameters in term-born control subjects and extremely preterm (EP) participants (with and without neonatal bronchopulmonary dysplasia [BPD]) throughout adolescence to 19 years of age. (A) Change in post-bronchodilator FEV₁ between 11 and 19 years. (B) Change in augmentation index between 11 and 19 years. (C) Seated blood pressure values at 6, 11, and 19 years. (D) Central blood pressure changes between 11 and 19 years. CI = confidence interval.