Perinatal risk factors and lung function at 8 years of age in extremely preterm infants: Insights from a new Japanese bronchopulmonary dysplasia classification.
{"title":"Perinatal risk factors and lung function at 8 years of age in extremely preterm infants: Insights from a new Japanese bronchopulmonary dysplasia classification.","authors":"Katsuya Hirata, Hidehiko Nakanishi, Fumihiko Namba, Narutaka Mochizuki, Shinya Hirano, Kazuko Wada, Masanori Fujimura","doi":"10.1016/j.pedneo.2025.05.005","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Advances in neonatal care have considerably improved the survival rates of extremely preterm infants. However, long-term pulmonary sequelae remain a major concern. A revised classification of bronchopulmonary dysplasia (BPD) in Japan highlights histological chorioamnionitis, small for gestational age (SGA), and a bubbly/cystic appearance on chest X-ray (bubbly/cystic CXR) as key risk factors. This study aimed to evaluate the effect of extremely preterm birth on lung function at school age.</p><p><strong>Methods: </strong>This retrospective study included 283 extremely preterm infants (born at <28 weeks of gestation) admitted to our institution between 1994 and 2013. Perinatal data and spirometry results obtained at 8 years of age were analyzed. Logistic regression analysis was performed to assess the association of histological chorioamnionitis, SGA, and bubbly/cystic CXR with obstructive (FEV<sub>1</sub> [forced expiratory volume in 1 s]/FVC [forced vital capacity] < LLN [lower limit of normal]), restrictive (FEV<sub>1</sub>/FVC ≥ LLN and FVC < LLN), and mixed (FEV<sub>1</sub>/FVC < LLN and FVC < LLN) patterns, with adjustments for gestational age, sex, and birth year.</p><p><strong>Results: </strong>Extremely preterm infants exhibited lower z-scores for FEV<sub>1</sub>/FVC, FEV<sub>1</sub>, and FVC than the predicted values based on age, height, and sex. Bubbly/cystic CXR findings was associated with an increased risk of obstructive (adjusted odds ratio [aOR], 2.30; 95 % confidence interval [CI], 1.12-4.72) and mixed patterns (aOR, 3.51; 95 % CI, 1.19-10.4). SGA was a risk factor for a restrictive pattern (aOR, 2.81; 95 % CI, 1.37-5.74).</p><p><strong>Conclusion: </strong>Bubbly/cystic CXR findings and SGA status, key components of the revised Japanese BPD classification, were significantly associated with long-term pulmonary function abnormalities in extremely preterm infants, characterized predominantly by obstructive/mixed and restrictive patterns, respectively. These findings highlight the importance of targeted strategies to address specific perinatal risk factors and improve long-term pulmonary outcomes in this high-risk population.</p>","PeriodicalId":56095,"journal":{"name":"Pediatrics and Neonatology","volume":" ","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatrics and Neonatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.pedneo.2025.05.005","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Advances in neonatal care have considerably improved the survival rates of extremely preterm infants. However, long-term pulmonary sequelae remain a major concern. A revised classification of bronchopulmonary dysplasia (BPD) in Japan highlights histological chorioamnionitis, small for gestational age (SGA), and a bubbly/cystic appearance on chest X-ray (bubbly/cystic CXR) as key risk factors. This study aimed to evaluate the effect of extremely preterm birth on lung function at school age.
Methods: This retrospective study included 283 extremely preterm infants (born at <28 weeks of gestation) admitted to our institution between 1994 and 2013. Perinatal data and spirometry results obtained at 8 years of age were analyzed. Logistic regression analysis was performed to assess the association of histological chorioamnionitis, SGA, and bubbly/cystic CXR with obstructive (FEV1 [forced expiratory volume in 1 s]/FVC [forced vital capacity] < LLN [lower limit of normal]), restrictive (FEV1/FVC ≥ LLN and FVC < LLN), and mixed (FEV1/FVC < LLN and FVC < LLN) patterns, with adjustments for gestational age, sex, and birth year.
Results: Extremely preterm infants exhibited lower z-scores for FEV1/FVC, FEV1, and FVC than the predicted values based on age, height, and sex. Bubbly/cystic CXR findings was associated with an increased risk of obstructive (adjusted odds ratio [aOR], 2.30; 95 % confidence interval [CI], 1.12-4.72) and mixed patterns (aOR, 3.51; 95 % CI, 1.19-10.4). SGA was a risk factor for a restrictive pattern (aOR, 2.81; 95 % CI, 1.37-5.74).
Conclusion: Bubbly/cystic CXR findings and SGA status, key components of the revised Japanese BPD classification, were significantly associated with long-term pulmonary function abnormalities in extremely preterm infants, characterized predominantly by obstructive/mixed and restrictive patterns, respectively. These findings highlight the importance of targeted strategies to address specific perinatal risk factors and improve long-term pulmonary outcomes in this high-risk population.
期刊介绍：
Pediatrics and Neonatology is the official peer-reviewed publication of the Taiwan Pediatric Association and The Society of Neonatology ROC, and is indexed in EMBASE and SCOPUS. Articles on clinical and laboratory research in pediatrics and related fields are eligible for consideration.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
