Robert S. Tepper MD, PhD , Brandie D. Wagner PhD , Jeffrey Bjerregaard RRT , Christina Tiller RRT , Laura Amos RN , Greg Sokol MD , Dominic Adducci BS , Steven H. Abman MD
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引用次数: 0
Abstract
Objective
To determine whether airway and parenchymal function identifies subgroups of infants born preterm according to the predominant pulmonary pathophysiology, and whether these subgroups have different risks for respiratory disease during infancy.
Study design
We prospectively enrolled a cohort of 125 infants born preterm with planned clinical follow-up after neonatal intensive care unit discharge. The study included monthly questionnaires for wheeze and visits to a physician or care provider for any respiratory illness. In addition, infant lung function testing near 5 months corrected-age included measures of airways and parenchymal function using forced expiratory flows, alveolar volume (VA), and the carbon monoxide transfer constant (diffusion capacity of lung [DL]/VA). Phenotypes were defined using 2 approaches: an a priori defined phenotypes based on forced expiratory flow 75% and DL/VA z-scores, and an unbiased approach to classifying infants using k-means clustering.
Results
We identified 4 pulmonary physiologic phenotypes that distinguished participants with predominantly decreased airway and/or parenchymal function. Although the worst physiologic phenotypes were associated with a lower gestational age at birth, these phenotypes had a better predictive value than gestational age, sex, and diagnosis of bronchopulmonary dysplasia for increased respiratory morbidity during infancy (area under the curve = 0.71 vs 0.63 for respiratory illness and 0.69 vs 0.63 for wheeze).
Conclusions
Physiologic pulmonary phenotypes of infants born preterm were associated with differential risks for respiratory morbidities as infants, which may identify heterogeneous risks for long-term respiratory sequelae to individualize therapeutic strategies.
期刊介绍:
The Journal of Pediatrics is an international peer-reviewed journal that advances pediatric research and serves as a practical guide for pediatricians who manage health and diagnose and treat disorders in infants, children, and adolescents. The Journal publishes original work based on standards of excellence and expert review. The Journal seeks to publish high quality original articles that are immediately applicable to practice (basic science, translational research, evidence-based medicine), brief clinical and laboratory case reports, medical progress, expert commentary, grand rounds, insightful editorials, “classic” physical examinations, and novel insights into clinical and academic pediatric medicine related to every aspect of child health. Published monthly since 1932, The Journal of Pediatrics continues to promote the latest developments in pediatric medicine, child health, policy, and advocacy.
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Pulmonology
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