Ah-Fong Hoo

The impact of birth before 27 completed weeks of gestation on infant pulmonary function (PF) was explored in a multi‐ethnic population in comparison to more mature preterm controls (PTC) and healthy fullterm infants. Plethysmographic lung volume (FRC_pleth) and forced expired volume (FEV_0.5) were obtained at ∼12 months post‐term age in 52 extremely preterm (EP) infants (median [range] gestational age [GA]: 26 [23–27] weeks; 40% White mothers; 79% with BPD), 41 PTC (GA:35 [30–36] weeks; 37% White mothers) and 95 fullterm infants (GA:40 [37–42] weeks; 86% White mothers). Using reference equations based on identical equipment and techniques, results were expressed as z‐scores to adjust for age, sex and body size. FEV_0.5 was significantly lower in EP infants when compared with PTC (mean difference [95% CI]: −1.02[−1.60; −0.44] z‐scores, P < 0.001), as was forced vital capacity (FVC) but there were no significant differences in FRC_pleth or FEV_0.5/FVC ratio. FEV_0.5, FVC, and FEV_0.5/FVC were significantly lower in both preterm groups when compared with fullterm controls. On multivariable analyses of the combined preterm dataset: FEV_0.5 at ∼1 year was 0.11 [0.05; 0.17] z‐scores higher/week GA, and 1.28 (0.49; 2.08) z‐scores lower in EP infants with prior BPD. Among non‐white preterm infants, FEV_0.5 was 0.70 (0.17; 1.24) z‐scores lower, with similar reductions in FVC, such that there were no ethnic differences in FEV_0.5/FVC. Similar ethnic differences were observed among fullterm infants. These results confirm the negative impact of preterm birth on subsequent lung development, especially following a diagnosis of BPD, and emphasize the importance of taking ethnic background into account when interpreting results during infancy as in older subjects. Pediatr Pulmonol. 2014; 49:679–687.

Background Long-term benefits of newborn screening (NBS) for cystic fibrosis (CF) have been established with respect to nutritional status, but effects on pulmonary health remain unclear. Hypothesis With early diagnosis and commencement of standardised treatment, lung function at ∼3 months of age is normal in NBS infants with CF. Methods Lung clearance index (LCI) and functional residual capacity (FRC) using multiple breath washout (MBW), plethysmographic (pleth) FRC and forced expirations from raised lung volumes were measured in 71 infants with CF (participants in the London CF Collaboration) and 54 contemporaneous healthy controls age ∼3 months. Results Compared with controls, and after adjustment for body size and age, LCI, FRC_MBW and FRC_pleth were significantly higher in infants with CF (mean difference (95% CI): 0.5 (0.1 to 0.9), p=0.02; 0.4 (0.1 to 0.7), p=0.02 and 0.9 (0.4 to 1.3), p0.5) and flows (FEF_25–75) were significantly lower (−0.9 (−1.3 to −0.6), p1.96 z-scores) and 25% (17/68) an abnormally low FEV_0.5 (below −1.96 z-scores). While only eight infants with CF had abnormalities of LCI and FEV_0.5, using both techniques identified abnormalities in 35% (24/68). Hyperinflation (FRC_pleth >1.96 z-scores) was identified in 18% (10/56) of infants with CF and was significantly correlated with diminished FEF_25–75 (r=−0.43, p0.5. Conclusion Despite early diagnosis of CF by NBS and protocol-driven treatment in specialist centres, abnormal lung function, with increased ventilation inhomogeneity and hyperinflation and diminished airway function, is evident in many infants with CF diagnosed through NBS by 3 months of age.