Lung function outcomes in adults born extremely preterm across three decades of advancing perinatal medicine

Abstract

Aim

Advances in perinatal medicine from 1980 to 2000 improved survival in extremely preterm (EP) neonates. Long-term effects of these developments remain unclear, and we aimed to investigate potential cohort effects on adult lung function.

Methods

Three 18-year-old population-based cohorts born at ≤28 weeks gestation or with birthweight ≤1000 g during 1982–85, 1991–92 and 1999–2000 and term-controls underwent spirometry, body plethysmography, and tests of lung diffusing capacity, bronchodilator reversibility, and airway hyperresponsiveness. We used Welch's t-tests to compare term- with EP-born as a group and split by bronchopulmonary dysplasia (BPD), and regression models to test group/cohort interactions.

Results

In all EP-born cohorts, z-scores for FEV₁, FEV₁/FVC, FEF_25%–75%, DLCO and KCO were reduced compared with term-born. For the 82–85, 91–92 and 99–00 cohorts, deficits for z-FEV₁ and z-DLCO were 1.23 and 0.53; 0.68 and 0.92; and 0.51 and 0.57, respectively (p ≤0.01 for all). Cohort analyses showed stable lung function across the three cohorts overall, but improvements across cohorts for the BPD subgroups in z-FEV₁, z-FEV₁/FVC, and z-FEF_25%–75%.

Conclusion

Adults born EP across three formative decades of neonatal care had stable lung function overall, with notable improvements in BPD subgroups across cohorts.