The EPICure Study: Association between Hemodynamics and Lung Function at 11 Years after Extremely Preterm Birth

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• 作者：Charlotte E. Bolton ; MD ; FRCP¹ ; ^{charlotte.bolton@nottingham.ac.uk} ; Janet Stocks ; PhD² ; Enid Hennessy ; PhD³ ; John R. Cockcroft ; FRCP⁴ ; Joseph Fawke ; MRCPCH⁵ ; Sooky Lum ; PhD² ; Carmel M. McEniery ; PhD⁶ ; Ian B. Wilkinson ; FRCP ; DM⁶ ; Neil Marlow ; DM ; FMedSci⁷
• 关键词：AIx ; Augmentation index ; BP ; Blood pressure ; BPD ; Bronchopulmonary dysplasia ; COPD ; Chronic obstructive pulmonary disease ; EP ; Extremely preterm ; FEF25-75 ; Forced mid-expiratory flow ; FEV1 ; Forced expiratory volume in 1 second ; FVC ; Forced vital capacity
• 刊名：The Journal of Pediatrics
• 出版年：2012
• 出版时间：October, 2012
• 年：2012
• 卷：161
• 期：4
• 页码：595-601.e2
• 全文大小：240 K

文摘

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Objective

To investigate the relationship between disturbed lung function and large-artery hemodynamics in school-age children born extremely preterm (EP) (at 25 completed weeks of gestation or less).

Study design

This was a cross-sectional study of participants from the EPICure study, now aged 11 years (n = 66), and 86 age- and sex-matched term-born classmates. Spirometry parameters (including forced expiratory volume in 1 second), blood pressure, and augmentation index (AIx, a composite of arterial stiffness and global wave reflections) were measured.

Results

Compared with their classmates, the EP children had significantly impaired lung function, particularly those with neonatal bronchopulmonary dysplasia. Peripheral blood pressure did not differ significantly between the 2 groups, but AIx values were on average 5 % higher (95 % CI, 2 % -8 % ) in the preterm infants, remaining significant after adjustment for potential confounders. Neonatal bronchopulmonary dysplasia status was not related to AIx. Lung function and maternal smoking were independently associated with AIx; AIx increased by 2.7 % per z-score reduction in baseline forced expiratory volume in 1 second and by 4.9 % in those whose mothers smoked during pregnancy.

Conclusion

The independent association between impaired lung function and cardiovascular physiology in early adolescence implies higher cardiovascular risk for children born EP, and suggests that prevention of chronic neonatal lung disease may be a priority in reducing later cardiovascular risk in preterm infants.