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Encouraging pulmonary outcome for surviving, neurologically intact extremely premature infants in the post surfactant era.
MedLine Citation:
PMID:  22423043     Owner:  NLM     Status:  Publisher    
Abstract OBJECTIVES:To determine long term pulmonary outcome of extreme prematurity at a single tertiary center, 1997-2001 in the post surfactant era. METHODS:We assessed symptoms, exhaled NO, spirometry, methacholine challenge (PC20), lung volumes, diffusion and cardiopulmonary exercise tolerance. RESULTS:Of 279 infants born, 192 survived to discharge and 79 of these developed BPD (65 mild, 12 moderate, 2 severe). We studied a subgroup of 53 neurologically intact preterm subjects at aged 10±1.5y: 28 with BPD-21 mild, 7 moderate and none severe- (born: 26.2 ±1.4 wks, birth weight 821 ±164 gm) and 25 without BPD (born: 27.2 ±1 wks, birth weight 1050 ± 181 gm), compared to 23 term controls. Of BPD subjects, 21 were mild, 7 moderate and none severe.77.4% received antenatal steroids and 83% post-natal surfactant. 60% preterm subjects wheezed at < 2y compared to 13% controls (p<0.001) but only 13% wheezed in the past year, compared to 0% controls (ns). For preterm subjects and controls respectively (mean± s.d., %predicted): FEV1 was 85±10% and 94±10% (p<0.001), with limited reversibility; RV/TLC was 29.3±5.5 and 25±8% (p<0.05); Diffusing capacity/alveolar volume was 89.6±9.2% and 97±10% (p<0.005); PC20 mg/ml was 6.5±5.8 and 11.7±5.5 (p<0.001). PC20 was <4mg/ml in 49% preterm subjects despite normal exhaled NO. Most measurements were similar for BPD and non-BPD premature subjects. Peak oxygen consumption and breathing reserve were normal, but maximal load (watts, mean ± s.d, %predicted) was 69±15% for BPD compared with 88±23% for non BPD and 86±20% for controls (p< 0.01). CONCLUSIONS:Pulmonary outcome was encouraging at mid-childhood for neurologically intact survivors in the post surfactant era. Despite mechanical ventilation and oxygen therapy, most had no or mild BPD. Changes found probably reflect hypoplastic lungs of prematurity.
Eytan Kaplan; Ephraim Bar Yishay; Dario Prais; Gil Klinger; Meir Mei Zahav; Huda Mussaffi; Guy Steuer; Shai Hananya; Yelena Matyashuk; Nassrin Gabarra; Lea Sirota; Hannah Blau
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-3-15
Journal Detail:
Title:  Chest     Volume:  -     ISSN:  1931-3543     ISO Abbreviation:  -     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-3-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1 Pulmonary Institute and.
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