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ARTERIAL STIFFNESS AND LUNG FUNCTION IN EXTREMELY PRETERM CHILDREN AGED 11 YEARS

J A Fawke¹, C E Bolton², J R Cockcroft³, J Stocks⁴, N Marlow¹

¹ Academic Department of Child Health, Nottingham University, Nottingham, UK
² Department of Respiratory Medicine, Cardiff University, Cardiff, Wales, UK
³ Wales Heart Research Institute, Cardiff University, Cardiff, Wales, UK
⁴ Portex Respiratory Unit, UCL, Institute of Child Health, London, UK

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Background: Poor lung function as an adult predicts increased arterial stiffness in later life, suggesting a common antecedent. The increasing numbers of ex-preterm children surviving with bronchopulmonary dysplasia may therefore be at particular risk of later cardiovascular disease. We compared lung function and arterial stiffness in 65 11-year-old children born extremely preterm (<26 weeks gestation) and 85 age/sex-matched term-born classmates.

Method: Trained researchers, blind to extremely preterm status performed spirometry. Results were expressed as Z scores. Arterial waveforms were evaluated by radial, carotid and femoral applanation tonometry (SphygmoCor) with augmentation index (AIx) and aortic pulse wave velocity (PWV) calculated as measures of arterial stiffness.

Results: Forced expired flows and volumes were reduced in extremely preterm children compared with controls. PWV, peripheral and central systolic blood pressure were similar but peripheral mean arterial pressure was higher in extremely preterm children. AIx was greater in extremely preterm children, even after adjustment for known confounders. Among the extremely preterm group, AIx was associated with both forced expiratory flow (FEF)_25–75 (β –2.51, p = 0.006) and forced expiratory volume in 1 s (FEV₁) (β –2.15, p = 0.02) Z scores, but not with forced vital capacity (FVC) or FEV₁/FVC. No such relationship was found in controls.

Conclusions: Extremely preterm children have poorer lung function than peers and greater arterial stiffness in proportion to their respiratory impairment, supporting the association found in adults. This may have relevance for future cardiovascular risk following extremely preterm birth.