Pulmonary function tests in extremely low gestational age infants at one year of age
Corresponding Author
Judith A. Voynow MD
Division of Pediatric Pulmonology, Children's Hospital of Richmond at VCU, Richmond, Virginia, USA
Correspondence Judith A. Voynow, Division of Pediatric Pulmonology, Children's Hospital of Richmond at VCU, PO Box 980315, 1000 E. Broad St., Richmond, VA 23298, USA.
Email: [email protected]
Contribution: Conceptualization (lead), Funding acquisition (equal), Investigation (equal), Project administration (equal), Writing - original draft (lead), Writing - review & editing (lead)
Search for more papers by this authorRui Feng PhD
Department of Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Contribution: Formal analysis (lead), Methodology (equal), Writing - original draft (equal), Writing - review & editing (equal)
Search for more papers by this authorClement L. Ren MD
Division of Pediatric Pulmonology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
Division of Pediatric Pulmonology, University of Rochester, Rochester, New York, USA
Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indiana University, Indianapolis, Indiana, USA
Contribution: Conceptualization (equal), Funding acquisition (equal), Investigation (equal), Project administration (equal), Supervision (equal), Writing - original draft (equal), Writing - review & editing (equal)
Search for more papers by this authorAndrew M. Dylag MD
Division of Neonatology, University of Rochester, Rochester, New York, USA
Contribution: Formal analysis (supporting), Writing - review & editing (equal)
Search for more papers by this authorJames S. Kemp MD
Division of Pediatric Pulmonology, Washington University Medical Center, St. Louis, Missouri, USA
Contribution: Investigation (equal), Writing - review & editing (supporting)
Search for more papers by this authorKaren McDowell MD
Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
Contribution: Investigation (equal), Writing - review & editing (supporting)
Search for more papers by this authorJack Sharp MD
Division of Pediatric Pulmonology, Duke University Medical Center, Durham, North Carolina, USA
Division of Pediatric Pulmonology, Texas Children's Hospital, Woodlands, Texas, USA
Search for more papers by this authorPaul E. Moore MD
Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Contribution: Investigation (equal), Writing - review & editing (supporting)
Search for more papers by this authorEric Eichenwald MD
Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
Division of Neonatology, University of Texas Health Science Center- Houston, Houston, Texas, USA
Contribution: Investigation (supporting), Writing - review & editing (supporting)
Search for more papers by this authorHoward Panitch MD
Division of Pediatric Pulmonology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
Search for more papers by this authorCharles Clem RRT
Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indiana University, Indianapolis, Indiana, USA
Contribution: Data curation (equal), Supervision (equal)
Search for more papers by this authorRobin Johnson RRT
Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
Contribution: Data curation (equal), Supervision (equal)
Search for more papers by this authorStephanie D. Davis MD
Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indiana University, Indianapolis, Indiana, USA
Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
Contribution: Conceptualization (lead), Funding acquisition (equal), Methodology (lead), Resources (equal), Supervision (equal), Writing - original draft (equal), Writing - review & editing (equal)
Search for more papers by this authorCorresponding Author
Judith A. Voynow MD
Division of Pediatric Pulmonology, Children's Hospital of Richmond at VCU, Richmond, Virginia, USA
Correspondence Judith A. Voynow, Division of Pediatric Pulmonology, Children's Hospital of Richmond at VCU, PO Box 980315, 1000 E. Broad St., Richmond, VA 23298, USA.
Email: [email protected]
Contribution: Conceptualization (lead), Funding acquisition (equal), Investigation (equal), Project administration (equal), Writing - original draft (lead), Writing - review & editing (lead)
Search for more papers by this authorRui Feng PhD
Department of Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Contribution: Formal analysis (lead), Methodology (equal), Writing - original draft (equal), Writing - review & editing (equal)
Search for more papers by this authorClement L. Ren MD
Division of Pediatric Pulmonology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
Division of Pediatric Pulmonology, University of Rochester, Rochester, New York, USA
Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indiana University, Indianapolis, Indiana, USA
Contribution: Conceptualization (equal), Funding acquisition (equal), Investigation (equal), Project administration (equal), Supervision (equal), Writing - original draft (equal), Writing - review & editing (equal)
Search for more papers by this authorAndrew M. Dylag MD
Division of Neonatology, University of Rochester, Rochester, New York, USA
Contribution: Formal analysis (supporting), Writing - review & editing (equal)
Search for more papers by this authorJames S. Kemp MD
Division of Pediatric Pulmonology, Washington University Medical Center, St. Louis, Missouri, USA
Contribution: Investigation (equal), Writing - review & editing (supporting)
Search for more papers by this authorKaren McDowell MD
Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
Contribution: Investigation (equal), Writing - review & editing (supporting)
Search for more papers by this authorJack Sharp MD
Division of Pediatric Pulmonology, Duke University Medical Center, Durham, North Carolina, USA
Division of Pediatric Pulmonology, Texas Children's Hospital, Woodlands, Texas, USA
Search for more papers by this authorPaul E. Moore MD
Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Contribution: Investigation (equal), Writing - review & editing (supporting)
Search for more papers by this authorEric Eichenwald MD
Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
Division of Neonatology, University of Texas Health Science Center- Houston, Houston, Texas, USA
Contribution: Investigation (supporting), Writing - review & editing (supporting)
Search for more papers by this authorHoward Panitch MD
Division of Pediatric Pulmonology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
Search for more papers by this authorCharles Clem RRT
Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indiana University, Indianapolis, Indiana, USA
Contribution: Data curation (equal), Supervision (equal)
Search for more papers by this authorRobin Johnson RRT
Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
Contribution: Data curation (equal), Supervision (equal)
Search for more papers by this authorStephanie D. Davis MD
Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indiana University, Indianapolis, Indiana, USA
Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
Contribution: Conceptualization (lead), Funding acquisition (equal), Methodology (lead), Resources (equal), Supervision (equal), Writing - original draft (equal), Writing - review & editing (equal)
Search for more papers by this authorPortions of this manuscript were presented by: Voynow JA, Davis SD, Feng R, Infant PFTs at One Year of Life in Extremely Low Gestational Age Infants, The PROP Cohort, PAS, Baltimore, MD, May 2016.
Abstract
Rationale
Identifying neonatal and post-discharge exposures among extremely low gestational age newborns (ELGANs) that drive increased pulmonary morbidity and abnormal lung function at 1 year of age proves challenging.
Objective
The NIH-sponsored Prematurity and Respiratory Outcomes Program (PROP), evaluated infant pulmonary function tests (iPFTs) at 1 year corrected age to determine which demographic and clinical factors are associated with abnormal lung function.
Methods
iPFTs were performed on a PROP subcohort of 135 participants following Institutional Review Board (IRB)-approved written consent. Demographic data, Neonatal Intensive Care Unit (NICU) clinical care, and post-NICU exposures were analyzed for association with iPFTs.
Main Results
A significant decrease in forced expiratory volume at 0.5 s (FEV0.5) and/or forced expiratory flows at 75% of forced vital capacity (FEF75), were associated with male sex and African American race. Clinical factors including longer duration of ventilatory support, exposure to systemic steroids, and weight less than the 10th percentile at 36 weeks postmenstrual age were also associated with airflow obstruction, whereas supplemental oxygen requirement and bronchopulmonary dysplasia were not. Additionally, the need for respiratory medications, technology, or hospitalizations during the first year, ascertained by a quarterly survey, were the only post-NICU factors associated with decreased FEV0.5 and FEF75. Only 7% of infants had reversible airflow obstruction.
Conclusions
Neonatal demographic factors, respiratory support in the NICU, and a history of greater post-NICU medical utilization for respiratory disease had the strongest association with lower lung function at 1 year in ELGANs.
Open Research
DATA AVAILABILITY STATEMENT
The data that supports the findings of this study are available in the supplementary material of this article.
Supporting Information
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| ppul25757-sup-0001-supplement_Table_SE1.docx24.4 KB | Supporting information. |
| ppul25757-sup-0002-Supplement_Table_SE2.docx15.8 KB | Supporting information. |
| ppul25757-sup-0003-Supplement_Table_SE3.docx15.7 KB | Supporting information. |
| ppul25757-sup-0004-Supplement_Table_SE4.docx15 KB | Supporting information. |
| ppul25757-sup-0005-Supplement_Table_SE5.docx15.2 KB | Supporting information. |
| ppul25757-sup-0006-Supplement_Table_SE6_Clean.docx19.3 KB | Supporting information. |
| ppul25757-sup-0007-Supplemental_Table_SE7_CLEAN.docx16.7 KB | Supporting information. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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