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Expiratory airflow limitation in adults born extremely preterm: A systematic review and meta-analysis

Extreme preterm (EP) birth, denoting delivery before the onset of the third trimester, interrupts intrauterine development and causes significant early-life pulmonary trauma, thereby posing a lifelong risk to respiratory health. We conducted a systematic review and meta-analysis to investigate adult...

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Main Authors: Lillebøe, Henriette Lahn-Johannessen, Engeseth, Merete Salveson, Clemm, Hege Synnøve Havstad, Halvorsen, Thomas, Røksund, Ola Drange, Potrebny, Thomas, Vollsæter, Maria
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creator Lillebøe, Henriette Lahn-Johannessen
Engeseth, Merete Salveson
Clemm, Hege Synnøve Havstad
Halvorsen, Thomas
Røksund, Ola Drange
Potrebny, Thomas
Vollsæter, Maria
description Extreme preterm (EP) birth, denoting delivery before the onset of the third trimester, interrupts intrauterine development and causes significant early-life pulmonary trauma, thereby posing a lifelong risk to respiratory health. We conducted a systematic review and meta-analysis to investigate adult lung function following EP birth (gestational age
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We conducted a systematic review and meta-analysis to investigate adult lung function following EP birth (gestational age &lt;28 weeks); comparing forced expiratory volume in first second (FEV1), forced vital capacity (FVC), and FEV1/FVC to reference values. Subgroup differences were explored based on timing of birth relative to surfactant use (1991) and bronchopulmonary dysplasia (BPD) status. Systematic searches were performed in Medline, EMBASE, Web of Science and Cochrane Central. Quality assessments were carried out using a modified Newcastle-Ottawa Scale for cohort studies. Sixteen studies encompassing 1036 EP-born adults were included, with 14 studies (n = 787) reporting data as %predicted, and 11 (n = 879) as z-score (not mutually exclusive). Overall mean [95 % confidence interval (CI)] %FEV1 was 85.30 (82.51; 88.09), %FVC was 94.33 (91.74; 96.91), and FEV1/FVC was 79.54 (77.71 to 81.38), all three with high heterogeneity. Overall mean (95 %CI) zFEV1 was −1.05 (-1.21; −0.90) and zFVC was. −0.45 (-0.59; −0.31), both with moderate heterogeneity. Subgroup analyses revealed no difference in FEV1 before versus after widespread use of surfactant, but more impairments after neonatal BPD. This meta-analysis revealed significant airflow limitation in EP-born adults, mostly explained by those with neonatal BPD. FEV1 was more reduced than FVC, and FEV1/FVC was at the lower limit of normal. Although at a group level, most adult EP-born individuals do not meet COPD criteria, these findings are concerning. Educational Aims The reader will come to appreciate: • Many adults who were born extremely preterm in the 1980s and 1990s, and who did not develop bronchopulmonary dysplasia, have lung function in the low normal range. • Extremely preterm born infants with a history of bronchopulmonary dysplasia may be at increased risk of a chronic obstructive pulmonary disease in middle age and older years based on the trajectory of their lung function. • Despite improved neonatal care and the advent of surfactant therapy, the rate of bronchopulmonary dysplasia has not decreased.</description><language>eng</language><publisher>Elsevier</publisher><creationdate>2024</creationdate><rights>info:eu-repo/semantics/openAccess</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,780,885,26567</link.rule.ids><linktorsrc>$$Uhttp://hdl.handle.net/11250/3163217$$EView_record_in_NORA$$FView_record_in_$$GNORA$$Hfree_for_read</linktorsrc></links><search><creatorcontrib>Lillebøe, Henriette Lahn-Johannessen</creatorcontrib><creatorcontrib>Engeseth, Merete Salveson</creatorcontrib><creatorcontrib>Clemm, Hege Synnøve Havstad</creatorcontrib><creatorcontrib>Halvorsen, Thomas</creatorcontrib><creatorcontrib>Røksund, Ola Drange</creatorcontrib><creatorcontrib>Potrebny, Thomas</creatorcontrib><creatorcontrib>Vollsæter, Maria</creatorcontrib><title>Expiratory airflow limitation in adults born extremely preterm: A systematic review and meta-analysis</title><description>Extreme preterm (EP) birth, denoting delivery before the onset of the third trimester, interrupts intrauterine development and causes significant early-life pulmonary trauma, thereby posing a lifelong risk to respiratory health. 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Overall mean (95 %CI) zFEV1 was −1.05 (-1.21; −0.90) and zFVC was. −0.45 (-0.59; −0.31), both with moderate heterogeneity. Subgroup analyses revealed no difference in FEV1 before versus after widespread use of surfactant, but more impairments after neonatal BPD. This meta-analysis revealed significant airflow limitation in EP-born adults, mostly explained by those with neonatal BPD. FEV1 was more reduced than FVC, and FEV1/FVC was at the lower limit of normal. Although at a group level, most adult EP-born individuals do not meet COPD criteria, these findings are concerning. 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We conducted a systematic review and meta-analysis to investigate adult lung function following EP birth (gestational age &lt;28 weeks); comparing forced expiratory volume in first second (FEV1), forced vital capacity (FVC), and FEV1/FVC to reference values. Subgroup differences were explored based on timing of birth relative to surfactant use (1991) and bronchopulmonary dysplasia (BPD) status. Systematic searches were performed in Medline, EMBASE, Web of Science and Cochrane Central. Quality assessments were carried out using a modified Newcastle-Ottawa Scale for cohort studies. Sixteen studies encompassing 1036 EP-born adults were included, with 14 studies (n = 787) reporting data as %predicted, and 11 (n = 879) as z-score (not mutually exclusive). Overall mean [95 % confidence interval (CI)] %FEV1 was 85.30 (82.51; 88.09), %FVC was 94.33 (91.74; 96.91), and FEV1/FVC was 79.54 (77.71 to 81.38), all three with high heterogeneity. Overall mean (95 %CI) zFEV1 was −1.05 (-1.21; −0.90) and zFVC was. −0.45 (-0.59; −0.31), both with moderate heterogeneity. Subgroup analyses revealed no difference in FEV1 before versus after widespread use of surfactant, but more impairments after neonatal BPD. This meta-analysis revealed significant airflow limitation in EP-born adults, mostly explained by those with neonatal BPD. FEV1 was more reduced than FVC, and FEV1/FVC was at the lower limit of normal. Although at a group level, most adult EP-born individuals do not meet COPD criteria, these findings are concerning. Educational Aims The reader will come to appreciate: • Many adults who were born extremely preterm in the 1980s and 1990s, and who did not develop bronchopulmonary dysplasia, have lung function in the low normal range. • Extremely preterm born infants with a history of bronchopulmonary dysplasia may be at increased risk of a chronic obstructive pulmonary disease in middle age and older years based on the trajectory of their lung function. • Despite improved neonatal care and the advent of surfactant therapy, the rate of bronchopulmonary dysplasia has not decreased.</abstract><pub>Elsevier</pub><oa>free_for_read</oa></addata></record>
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title Expiratory airflow limitation in adults born extremely preterm: A systematic review and meta-analysis
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