Anne-Marie Gibson

Lung function in adult survivors of very low birth weight, with and without bronchopulmonary dysplasia

The lung function outcome of cohorts of very low birth weight (VLBW; birth weight <1501 g) survivors born in the late 1970s or early 1980s into adulthood at an age when lung growth would be expected to have ceased is not well described. The aim of this study was to report lung function data in adulthood of VLBW survivors compared with normal birth weight controls (>2499 g), and in those who had bronchopulmonary dysplasia (BPD) compared with those without BPD.

Respiratory outcomes for the tiniest or most immature infants

Extremely low birth weight (<1000 g birth weight) or extremely preterm (<28 weeks of gestation) infants are surviving in greater numbers as neonatal care advances. Many of these survivors, especially those who develop bronchopulmonary dysplasia, have more respiratory ill health in the first years after discharge home, reduced respiratory function and impaired exercise capacity throughout childhood and into adulthood compared with term-born controls. It is important to establish the long-term respiratory outcomes for the tiniest or most immature survivors as they grow older, since they may contribute disproportionately to rates of chronic obstructive pulmonary disease and respiratory ill-health in adulthood.

Geographical Differences in First Acquisition of Pseudomonas aeruginosa in Cystic Fibrosis

RATIONALE Risk of infection with Pseudomonas aeruginosa in cystic fibrosis (CF) may be associated with environmental factors. OBJECTIVES To determine whether residential location is associated with risk of first acquisition of P. aeruginosa. METHODS We performed bronchoalveolar lavage and upper airway cultures in children newly diagnosed with CF to identify infection with P. aeruginosa during infancy and early childhood. Children were assessed according to their residence in a regional or metropolitan area. Multilocus sequence typing was used to determine P. aeruginosa genotype. An environmental questionnaire was also administered. MEASUREMENTS AND MAIN RESULTS A total of 105 of 120 (87.5%) infants diagnosed with CF were included in this study. Diagnosis in 65 infants (61.9%) followed newborn screening at mean age of 4.6 weeks. Sixty subjects (57.1%) were homozygous ΔF508, and 47 (44.8%) were female. Fifty-five (52.3%) infants were regional, of whom 26 (47.3%), compared with 9 of 50 (18.0%) metropolitan children, acquired infection with P. aeruginosa (odds ratio, 4.084; 95% confidence interval, 1.55-11.30). Age at acquisition was similar (regional: median, 2.31 yr; range, 0.27-5.96 yr; metropolitan: median, 3.10 yr, range, 0.89-3.70 yr). Strain typing identified P. aeruginosa genotypes often encountered in different ecological settings and little evidence of cross-infection. Ninety questionnaires (85.7%) were completed. Those who acquired P. aeruginosa were more likely to be living in a household that used water sprinkler systems (P = 0.032), but no differences were identified to explain increased risk of acquisition of P. aeruginosa in regional children. CONCLUSIONS Geographical difference in residence of children with CF was associated with increased risk of first acquisition of P. aeruginosa, usually with strains associated with the environment rather than with cross-infection.

Lung function in preschool children with a history of wheezing measured by forced oscillation and plethysmographic specific airway resistance.

Wheezing is common in preschool children, but objective evidence for airway obstruction and its reversibility are rarely available in clinical practice. We assessed whether abnormalities of lung function and bronchodilator response can be detected in preschool children using the forced oscillation technique and measurements of specific airway resistance.

Long-Term Outcomes After Mechanical Ventilation in Neonates

The following chapter begins with a brief overview of the development of mechanical ventilation in neonates and how advances in this field have led to improvements in both survival and morbidity. The importance of variables that make these neonates vulnerable to respiratory disease that warrants the initiation of mechanical ventilation is highlighted. For infants who received mechanical ventilation following respiratory failure, the short- and long-term respiratory function and neurological outcomes are discussed. The capacity of these neonates to undertake exercise in childhood is discussed in detail. Finally, the chapter discusses the future prospects for these patients.

82 Stability of Lung Function Tests Between 8 and 18 Years of Age of EPT/ELBW Survivors Compared with Term Controls

Aims To determine the stability of lung function test results of extremely preterm (EPT; < 28 weeks’ gestational age) or extremely low birthweight (ELBW; birthweight < 1000g) survivors between 8 and 18 years of age compared with term controls. Methods Eighteen-year follow-up of participants born either EPT/ELBW in 1991–92 in the state of Victoria and randomly selected term, normal birthweight controls. Lung volumes and flows, including the forced expired volume in 1 second (FEV1), forced vital capacity (FVC), the FEV1/FVC, and the forced expiratory flow (FEF25–75%) were measured at 8 and 18 years of age according to standard guidelines and results converted to Z-scores for age, height and gender. Results Lung function data were obtained from 187/298 (63%) EPT/ELBW subjects and 147/262 (56%) controls at both 8 and 18 years. There were strong positive relationships between lung function results at 18 years with results obtained at 8 years in both groups (Table). Abstract 82 Table 1 Lung function variable EPT/ELBW % variance Controls % variance FEV1 0.887 (0.058)* 56.0% 0.554 (0.071)* 29.4% FVC 0.676 (0.058)* 42.2% 0.586 (0.067)* 34.5% FEV1/FVC 0.422 (0.051)* 26.8% 0.384 (0.063)* 20.5% FEF25%-75% 0.772 (0.057)* 50.3% 0.561 (0.070)* 30.7% Changes in Respiratory Variables Between 8 and 18 Data are regression coefficients (SE); *P<0.001 Relationships between 8 and 18 years were significantly stronger for EPT/ELBW subjects for both FEV1 and FEF25–75% compared with controls. Conclusions There are strong linear relationships between lung function values at 8 and 18 years in both EPT/ELBW survivors and controls.