Pediatr Neonatol. 2025 Jun 20:S1875-9572(25)00120-2. doi: 10.1016/j.pedneo.2025.05.005. Online ahead of print.
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.
PMID:40579282 | DOI:10.1016/j.pedneo.2025.05.005
