Arch Dis Child. Published Online First: 18 June 2008. doi:10.1136/adc.2008.140830
Original articles |
Respiratory health in pre-school and school age children following extremely preterm birth
1 Barts and The London, Queen Mary's School of Medicine and Dentistry, United Kingdom
2 Univeristy of Nottingham, United Kingdom
3 University of Nottingham, United Kingdom
4 University of Warwick, United Kingdom
5 Homerton University Hospital, United Kingdom
6 Sheffield Teaching Hospitals NHS Trust, United Kingdom
* To whom correspondence should be addressed. E-mail: neil.marlow{at}nottingham.ac.uk.
Accepted 3 June 2008
Abstract
Rationale: Increasing survival at extremely low gestation is associated with very high rates of bronchopulmonary dysplasia, but is rarely quantified.
Objectives: To identify respiratory morbidity and risk factors in the EPICure cohort over the first 6 years.
Methods: 308 babies born at 
25 weeks of gestation in 1995 were followed up at 30m and 6y of age. Respiratory outcome was evaluated using clinical assessment and parental questionnaire and peak expiratory flow (PEF) at 6y.
Results: Of this population 74% received supplemental oxygen at 36 weeks PMA and 36% were discharged with supplemental oxygen which continued for a median of 2.5 months (75 percentile: 8.5m). 236 children were followed to 6 years. Respiratory symptoms and use of medication were more prevalent at 30mo and 6y in children with bronchopulmonary dysplasia (BPD) compared to those without. Children without BPD (n=56) were not significantly different from their classmates but had consistently higher prevalence. Symptoms, need for hospital admission and medication use had declined between 30m and 6y. 200 index children completed three peak expiratory flow measures; PEF was lower than in classmates (mean adjusted difference: 39 l/min (95%CI 30; 47)), lowest in children discharged home in oxygen and those with BPD. Gestational age, BPD, maternal smoking at home and in pregnancy were independent risk factors for symptoms but BPD the only independent associate of PEF.
Conclusion: Extremely preterm children have a continuum of poor respiratory health over the first 6 years, which is exacerbated by smoking in pregnancy and in the home.
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