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Geographical differences and temporal improvements in forced expiratory volume in 1 second of preterm-born children

Kotecha, Sarah J., Gibbons, James T. D., Course, Christopher W., Evans, Emily E., Simpson, Shannon J., Watkins, W. John ORCID: and Kotecha, Sailesh ORCID: 2022. Geographical differences and temporal improvements in forced expiratory volume in 1 second of preterm-born children. JAMA Pediatrics 176 (9) , pp. 867-877. 10.1001/jamapediatrics.2022.1990

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Importance Although preterm birth is associated with later deficits in lung function, there is a paucity of information on geographical differences and whether improvements occur over time, especially after surfactant was introduced. Objective To determine deficits in percentage predicted forced expiratory volume in 1 second (%FEV1) in preterm-born study participants, including those with bronchopulmonary dysplasia (BPD) in infancy, when compared with term-born control groups. Data Sources Eight databases searched up to December 2021. Study Selection Studies reporting spirometry for preterm-born participants with or without a term-born control group were identified. Data Extraction and Synthesis Data were extracted and quality assessed by 1 reviewer and checked by another. Data were pooled using random-effects models and analyzed using Review Manager and the R metafor package. Main Outcomes and Measures Deficits in %FEV1 between preterm-born and term groups. Associations between deficits in %FEV1 and year of birth, age, introduction of surfactant therapy, and geographical region of birth and residence were also assessed. Results From 16 856 titles, 685 full articles were screened: 86 with and without term-born control groups were included. Fifty studies with term controls were combined with the 36 studies from our previous systematic review, including 7094 preterm-born and 17 700 term-born participants. Of these studies, 45 included preterm-born children without BPD, 29 reported on BPD28 (supplemental oxygen dependency at 28 days), 26 reported on BPD36 (supplemental oxygen dependency at 36 weeks’ postmenstrual age), and 86 included preterm-born participants. Compared with the term-born group, the group of all preterm-born participants (all preterm) had deficits of %FEV1 of −9.2%; those without BPD had deficits of −5.8%, and those with BPD had deficits of approximately −16% regardless of whether they had BPD28 or BPD36. As year of birth increased, there was a statistically significant narrowing of the difference in mean %FEV1 between the preterm- and term-born groups for the all preterm group and the 3 BPD groups but not for the preterm-born group without BPD. For the all BPD group, when compared with Scandinavia, North America and western Europe had deficits of −5.5% (95% CI, −10.7 to −0.3; P = .04) and −4.1% (95% CI, −8.8 to 0.5; P = .08), respectively. Conclusions and Relevance Values for the measure %FEV1 were reduced in preterm-born survivors. There were improvements in %FEV1 over recent years, but geographical region had an association with later %FEV1 for the BPD groups.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Additional Information: This is an open access article distributed under the terms of the CC-BY License.
Publisher: American Medical Association
ISSN: 2168-6203
Funders: MRC
Date of First Compliant Deposit: 29 June 2022
Date of Acceptance: 13 April 2022
Last Modified: 10 Nov 2023 02:08

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