Pulmonary function and exercise capacity for ELBW survivors in preadolescence: effect of neonatal chronic lung disease

OBJECTIVE: To assess pulmonary function and exercise capacity of apparently asymptomatic children who were born extremely preterm. STUDY DESIGN: Pulmonary function and treadmill testing were performed on 50 children 9 to 15 years old who had birth weight <801 g (extremely low birth weight [ELBW]) and without apparent neurodevelopmental or pulmonary disabilities, compared with 25 children born at term with normal birth weight (NBW). Medical history and physical activity levels were assessed by parent questionnaire. Group differences were determined by two-sample t test. Secondary analysis was performed to assess significant influence of neonatal chronic lung disease (CLD) on outcome measures. RESULTS: Twenty percent of ELBW subjects but no subjects with NBW had clinically abnormal pulmonary function (>2 SD from norms, P=.026). All significant pulmonary function differences except peak expiratory flow rate percentages were accounted for by ELBW subjects who had CLD. Oxygen consumption measurements were significantly lower for subjects with ELBW (30.3+/-6.9 and 38.5+/-5.2 mL/kg/min, P=.000), independent of CLD status. CONCLUSION: Pulmonary function abnormalities consistent with obstructive lung disease were more frequently detected in ELBW children who had neonatal CLD. Low oxygen consumption measurements suggest a lower level of fitness for ELBW children compared with children with NBW.     

Recurrence of cardiorespiratory events following repeat DTaP-based combined immunization in very low birth weight premature infants

We evaluated the tolerance to immunization of 64 very low birth weight preterm infants. Thirty-three of the infants experienced a cardiorespiratory event after the first vaccination, and 6 of these 33 (18%) had a recurrence after the second vaccination, including 2 infants previously discharged to home. A cardiorespiratory event associated with the first vaccination was the sole risk factor for recurrence identified.     

Failure of conventional strategies to improve nutritional status in malnourished adolescents and adults with cystic fibrosis

The use of oral dietary supplements was compared with dietary counseling in 13 malnourished patients (3 males, mean age 18.1 years) with cystic fibrosis. Energy intake and nutritional status were evaluated over 3 months. There was no significant change in energy intake or percent ideal body weight in either group.     

Cardiovascular findings in very low birthweight schoolchildren with and without bronchopulmonary dysplasia

BACKGROUND: With the introduction of new therapies in peri- and neonatology, the clinical picture of bronchopulmonary dysplasia (BPD) seems to alter. The consequences of this "new BPD" are of interest. AIM: To evaluate cardiovascular findings during the surfactant era in very low birthweight (VLBW, birth weight < 1500 g) schoolchildren with and without BPD. METHODS: At 7-8 years of age, 34 VLBW children with BPD born in one hospital underwent blood pressure (BP) measurement, electrocardiography (ECG), two-dimensional Doppler and M-mode echocardiography, flow-volume spirometry and whole-body plethysmography. The age- and sex-matched control groups comprised 34 VLBW children without BPD (no-BPD group) and 34 term children (term group). RESULTS: The mean(SD) diastolic BP was significantly higher in the no-BPD than in the BPD group (65(9) vs. 59(8) mm Hg, p < 0.05). No clinically significant tricuspid regurgitations were found. The groups did not differ with respect to right ventricular systolic time intervals corrected for heart rate. The results of all M-mode measurements were within normal range. Compared to term controls, the BPD cases had lower mean(SD) forced expiratory flow in 1 s (90(14)% vs. 99(11)% of ref., p < 0.05) and more often high ratio of residual volume to total lung capacity (15(52%) vs. 4(13%), p < 0.01). No clinically significant correlations were found between current lung function and echocardiographic findings. CONCLUSION: In the surfactant era, school-aged VLBW survivors with and without BPD do not seem to evince indirect signs of elevated pulmonary pressure. The increased pulmonary vascular resistance associated with BPD appears to resolve with time more rapidly than abnormalities in respiratory function.