being born a few weeks early- does it matter? › ... › preterm.pdf · preterm birth by...
TRANSCRIPT
2014-09-20
1
Being born a few weeks early-does it matter
bull Background bull Mortalitymorbidity bull What is in the literature bull New results
Per Thunqvist Barnallergisektionens houmlstmoumlte Stockholm 2014
ABC of preterm birth BMJ 2004
Moderate-to late preterm
Preterm birth rate by country
Blencowe et al Lancet 20123792162-72
14-18 milj preterm birthyear
2014-09-20
2
Preterm birth by gestational age
84 moderat-to-late preterm
Figure 1 Average annual percentage change for preterm birth by country 1996ndash2008 Data series begins in 2000
Preterm birth time trends in Europe a study of 19 countries The Euro-Peristat Preterm Study Group BJOG 2013
Figure 1 Average annual percentage change for preterm birth by country 1996ndash2008 Data series begins in 2000
Preterm birth time trends in Europe a study of19 countries The Euro-Peristat Preterm Study Group BJOG 2013
2014-09-20
3
Maternal age and moderate-to-late preterm birth
bull Increased demand for assited reproductive technology bull Increased number of labor inductions bull Increased number of ceasaren sections
Infant mortality by gestational age
Proportion of infants with neonatal morbidity as a function of GA Newborn morbidity was
assessed by using a combination of indicators on infants hospital discharge record and
mortality data available from death certificates
Colin A A et al Pediatrics 2010126115-128
copy2010 by American Academy of Pediatrics
Neonaltal morbidity
2014-09-20
4
Fig 1 Respiratory morbidity in late preterm births ltceinline-figure baseline=00gt
Sarah J Kotecha Frank D Dunstan Sailesh Kotecha
Long term respiratory outcomes of late preterm-born infants
Seminars in Fetal and Neonatal Medicine Volume 17 Issue 2 2012 77 - 81
Respiratory perinatal morbidity
Moderately preterm children have more respiratory problems during their first 5 years of life than children born full term Vrijlandt EJ1 Kerstjens JM Duiverman EJ Bos AF Reijneveld SA
Meta-analysis of adjusted dosendashresponse association between gestational age (per week increase) and childhood wheezing disorders
Been JV Lugtenberg MJ Smets E van Schayck CP et al (2014) Preterm Birth and Childhood Wheezing Disorders A Systematic Review and Meta-Analysis PLoS Med 11(1) e1001596 doi101371journalpmed1001596 httpwwwplosmedicineorgarticleinfodoi101371journalpmed1001596
bull 1-14 years bull Apr 1 milj
2014-09-20
5
They conclude prematurity and wheeze bull OR 171 bull 137 lt 37 weeks vs 83 term Sub group analysis bull Very and extrem (lt 32 weeks) OR 30
bull Moderate-to-late preterm (32-36) OR 149
bull Every week 6 less risk of wheeze
Impaired lung function and health status in adult survivors of bronchopulmonary dysplasia Gough et al ERJ 2014
bull Mean age 24 bull Only small differences BPD (27 weeks) vs non BPD (31 weeks) bull Significant morbidity among BPD survivors
Stocks Hislop Sonnappa 2013
bull Surfactant pool increases bull Increased numbers of alveoli (dependent on elastin smooth
muscle capillary network) bull Inceased gas exchange surface (thinning of insterstial tissue)
Lung development during late Saccular and Alveolar period
2014-09-20
6
Prenatal factors
Airway and lung development are ldquoprogrammedrdquo before birth
(Barker BMJ 1991303)
bull Genes genpolymorfism epigenetics sex
bull Prenatal under nutrition birth weight
bull Exposions infections maternal smooking
bull Prematurity stage
Airway obstruction in Bronchopulmonal dysplasia BPD
Baraldi et Filippone N Eng J 2008
bull 8839 titles bull 59 studies preterm (lt 37 weeks) vs term
bull Born 1964 to 2000
bull 5-23 years
bull FEV1 procent predicted
2014-09-20
7
Lower lung function in no-BPD - 72 FEV1
Impaired lung function and health status in adult survivors of bronchopulmonary dysplasia Gough et al ERJ 2014
bull Non BPD ( mean 31 weeks) significantly lower lung function at 24 years
bull 30-34 week + controlls
bull Test 1 10 weeks bull Test 2 15 months
Growth rate of lung function i healthy preterm infants Friedrich et all Am J Crit Care 2007176
bull Tracking of lung function in infancy av moderate-to-late preterm birth
2014-09-20
8
Effect of late preterm birth on longitudinal lung spirometry in school age children and adolecents Kotecha S et al Thorax 201267
bull Lung function at 8-9 years lower after preterm birth 33-34 weeks of gestation bull No difference for 35-36 weeks compared to term
8-9 year follow-up
bull Increase in lung function from 8 to 17 years in 32-34 week of gestation- rdquocatch up growthrdquo
Effect of late preterm birth on longitudinal lung spirometry in school age children and adolecents Kotecha S et al Thorax 201267
14-17 year follow-up
Figure 2 Maximal exercise capacity Adjusted results expressed as least squared means for maximal exercise capacity (Watt) in relation to the major risk factors A - Gestational Age categories
Long-Term Impact of Preterm Birth on Exercise Capacity in Healthy Young Men A National Population-Based Cohort Study Jenny Svedenkrans12 Ewa Henckel12 Jan Kowalski1 Mikael Norman12 Kajsa Bohlin12
Exercise capacity after preterm birth is reduced
2014-09-20
9
Lung function at age 8 and 16 years after moderate-to-late preterm birth - a prospective cohort study Per Thunqvist12 Per M Gustafsson34 Erica S Schultz5 Tom Bellander56 Eva Berggren-Brostroumlm12 Mikael Norman7 Magnus Wickman15 Erik Meleacuten15 Jenny Hallberg15 Submitted
Diff 95 CI p-value
8 years (n=89)
FEV05 (ml) -508 -866-149 0005
FEV1 (ml) -291 -685103 0148
MEF50 (mls) -1537 -2669-405 0008
FVC (ml) -52 -504399 0821
FEV1FVC ( units) -13 -25-01 0027
16 years (n=107)
FEV05 (ml) -1267 -1985-548 0001
FEV1 (ml) -1202 -2072-331 0007
MEF50 (mls) -3931 -6070-1792 lt0001
FVC (ml) -209 -1199781 0679
FEV1FVC ( units) -24 -36-11 lt0001
Differences in lung function between term children and the moderate-to-late preterm group at 8 and 16 years of age term vs 32-36 weeks
bull Flows low bull Volume normal
Spirometric variables expressed as mean Z-scores and 95 confidence intervals for at 8 and 16 years of age for term and moderate-to-late preterm children
bull No catch up from 8 to 16 years of age
bull Instead augmented between age 8 and 16 years
2014-09-20
10
Diff 95 CI p-value
Spirometry at 8 years
(n=73)
FEV05 (ml) -458 -851-65 0022
FEV1 (ml) -288 -722146 0193
MEF50 (mls) -1665 -2911-419 0009
FVC (ml) -58 -555439 0818
FEV1FVC ( units) -12 -25005 0060
Spirometry at 16 years
(n=84)
FEV05 (ml) -1266 -2077-459 0002
FEV1 (ml) -1120 -2176-223 0016
MEF50 (mls) -4604 -7003-2205 lt0001
FVC (ml) 171 -9401282 0763
FEV1FVC ( units) -31 -45-17 lt0001
Differences in lung function between term children and the moderate-to-late preterm group at 8 and 16 years of age term vs 35-36 weeks
bull rdquosamerdquo differences for 35-36 weeks
ERS 2014
In conclusion
bull Preterm birth is common and particuarly moderate-to prematur birth
bull Perinatal mortality and morbidity is high after moderate-to-late preterm birth bull Respiratory morbidity continues to be higher during preschool age and
probably even in adulthood among former moderate-to-late preterm subjects
bull Lower lung function is found in infancy school age and adolecents after moderate-to-late preterm birth
bull This large group of individuals that do not reach maximal lung function peak could be at risk of future respiratory morbidity including COPD
2014-09-20
2
Preterm birth by gestational age
84 moderat-to-late preterm
Figure 1 Average annual percentage change for preterm birth by country 1996ndash2008 Data series begins in 2000
Preterm birth time trends in Europe a study of 19 countries The Euro-Peristat Preterm Study Group BJOG 2013
Figure 1 Average annual percentage change for preterm birth by country 1996ndash2008 Data series begins in 2000
Preterm birth time trends in Europe a study of19 countries The Euro-Peristat Preterm Study Group BJOG 2013
2014-09-20
3
Maternal age and moderate-to-late preterm birth
bull Increased demand for assited reproductive technology bull Increased number of labor inductions bull Increased number of ceasaren sections
Infant mortality by gestational age
Proportion of infants with neonatal morbidity as a function of GA Newborn morbidity was
assessed by using a combination of indicators on infants hospital discharge record and
mortality data available from death certificates
Colin A A et al Pediatrics 2010126115-128
copy2010 by American Academy of Pediatrics
Neonaltal morbidity
2014-09-20
4
Fig 1 Respiratory morbidity in late preterm births ltceinline-figure baseline=00gt
Sarah J Kotecha Frank D Dunstan Sailesh Kotecha
Long term respiratory outcomes of late preterm-born infants
Seminars in Fetal and Neonatal Medicine Volume 17 Issue 2 2012 77 - 81
Respiratory perinatal morbidity
Moderately preterm children have more respiratory problems during their first 5 years of life than children born full term Vrijlandt EJ1 Kerstjens JM Duiverman EJ Bos AF Reijneveld SA
Meta-analysis of adjusted dosendashresponse association between gestational age (per week increase) and childhood wheezing disorders
Been JV Lugtenberg MJ Smets E van Schayck CP et al (2014) Preterm Birth and Childhood Wheezing Disorders A Systematic Review and Meta-Analysis PLoS Med 11(1) e1001596 doi101371journalpmed1001596 httpwwwplosmedicineorgarticleinfodoi101371journalpmed1001596
bull 1-14 years bull Apr 1 milj
2014-09-20
5
They conclude prematurity and wheeze bull OR 171 bull 137 lt 37 weeks vs 83 term Sub group analysis bull Very and extrem (lt 32 weeks) OR 30
bull Moderate-to-late preterm (32-36) OR 149
bull Every week 6 less risk of wheeze
Impaired lung function and health status in adult survivors of bronchopulmonary dysplasia Gough et al ERJ 2014
bull Mean age 24 bull Only small differences BPD (27 weeks) vs non BPD (31 weeks) bull Significant morbidity among BPD survivors
Stocks Hislop Sonnappa 2013
bull Surfactant pool increases bull Increased numbers of alveoli (dependent on elastin smooth
muscle capillary network) bull Inceased gas exchange surface (thinning of insterstial tissue)
Lung development during late Saccular and Alveolar period
2014-09-20
6
Prenatal factors
Airway and lung development are ldquoprogrammedrdquo before birth
(Barker BMJ 1991303)
bull Genes genpolymorfism epigenetics sex
bull Prenatal under nutrition birth weight
bull Exposions infections maternal smooking
bull Prematurity stage
Airway obstruction in Bronchopulmonal dysplasia BPD
Baraldi et Filippone N Eng J 2008
bull 8839 titles bull 59 studies preterm (lt 37 weeks) vs term
bull Born 1964 to 2000
bull 5-23 years
bull FEV1 procent predicted
2014-09-20
7
Lower lung function in no-BPD - 72 FEV1
Impaired lung function and health status in adult survivors of bronchopulmonary dysplasia Gough et al ERJ 2014
bull Non BPD ( mean 31 weeks) significantly lower lung function at 24 years
bull 30-34 week + controlls
bull Test 1 10 weeks bull Test 2 15 months
Growth rate of lung function i healthy preterm infants Friedrich et all Am J Crit Care 2007176
bull Tracking of lung function in infancy av moderate-to-late preterm birth
2014-09-20
8
Effect of late preterm birth on longitudinal lung spirometry in school age children and adolecents Kotecha S et al Thorax 201267
bull Lung function at 8-9 years lower after preterm birth 33-34 weeks of gestation bull No difference for 35-36 weeks compared to term
8-9 year follow-up
bull Increase in lung function from 8 to 17 years in 32-34 week of gestation- rdquocatch up growthrdquo
Effect of late preterm birth on longitudinal lung spirometry in school age children and adolecents Kotecha S et al Thorax 201267
14-17 year follow-up
Figure 2 Maximal exercise capacity Adjusted results expressed as least squared means for maximal exercise capacity (Watt) in relation to the major risk factors A - Gestational Age categories
Long-Term Impact of Preterm Birth on Exercise Capacity in Healthy Young Men A National Population-Based Cohort Study Jenny Svedenkrans12 Ewa Henckel12 Jan Kowalski1 Mikael Norman12 Kajsa Bohlin12
Exercise capacity after preterm birth is reduced
2014-09-20
9
Lung function at age 8 and 16 years after moderate-to-late preterm birth - a prospective cohort study Per Thunqvist12 Per M Gustafsson34 Erica S Schultz5 Tom Bellander56 Eva Berggren-Brostroumlm12 Mikael Norman7 Magnus Wickman15 Erik Meleacuten15 Jenny Hallberg15 Submitted
Diff 95 CI p-value
8 years (n=89)
FEV05 (ml) -508 -866-149 0005
FEV1 (ml) -291 -685103 0148
MEF50 (mls) -1537 -2669-405 0008
FVC (ml) -52 -504399 0821
FEV1FVC ( units) -13 -25-01 0027
16 years (n=107)
FEV05 (ml) -1267 -1985-548 0001
FEV1 (ml) -1202 -2072-331 0007
MEF50 (mls) -3931 -6070-1792 lt0001
FVC (ml) -209 -1199781 0679
FEV1FVC ( units) -24 -36-11 lt0001
Differences in lung function between term children and the moderate-to-late preterm group at 8 and 16 years of age term vs 32-36 weeks
bull Flows low bull Volume normal
Spirometric variables expressed as mean Z-scores and 95 confidence intervals for at 8 and 16 years of age for term and moderate-to-late preterm children
bull No catch up from 8 to 16 years of age
bull Instead augmented between age 8 and 16 years
2014-09-20
10
Diff 95 CI p-value
Spirometry at 8 years
(n=73)
FEV05 (ml) -458 -851-65 0022
FEV1 (ml) -288 -722146 0193
MEF50 (mls) -1665 -2911-419 0009
FVC (ml) -58 -555439 0818
FEV1FVC ( units) -12 -25005 0060
Spirometry at 16 years
(n=84)
FEV05 (ml) -1266 -2077-459 0002
FEV1 (ml) -1120 -2176-223 0016
MEF50 (mls) -4604 -7003-2205 lt0001
FVC (ml) 171 -9401282 0763
FEV1FVC ( units) -31 -45-17 lt0001
Differences in lung function between term children and the moderate-to-late preterm group at 8 and 16 years of age term vs 35-36 weeks
bull rdquosamerdquo differences for 35-36 weeks
ERS 2014
In conclusion
bull Preterm birth is common and particuarly moderate-to prematur birth
bull Perinatal mortality and morbidity is high after moderate-to-late preterm birth bull Respiratory morbidity continues to be higher during preschool age and
probably even in adulthood among former moderate-to-late preterm subjects
bull Lower lung function is found in infancy school age and adolecents after moderate-to-late preterm birth
bull This large group of individuals that do not reach maximal lung function peak could be at risk of future respiratory morbidity including COPD
2014-09-20
3
Maternal age and moderate-to-late preterm birth
bull Increased demand for assited reproductive technology bull Increased number of labor inductions bull Increased number of ceasaren sections
Infant mortality by gestational age
Proportion of infants with neonatal morbidity as a function of GA Newborn morbidity was
assessed by using a combination of indicators on infants hospital discharge record and
mortality data available from death certificates
Colin A A et al Pediatrics 2010126115-128
copy2010 by American Academy of Pediatrics
Neonaltal morbidity
2014-09-20
4
Fig 1 Respiratory morbidity in late preterm births ltceinline-figure baseline=00gt
Sarah J Kotecha Frank D Dunstan Sailesh Kotecha
Long term respiratory outcomes of late preterm-born infants
Seminars in Fetal and Neonatal Medicine Volume 17 Issue 2 2012 77 - 81
Respiratory perinatal morbidity
Moderately preterm children have more respiratory problems during their first 5 years of life than children born full term Vrijlandt EJ1 Kerstjens JM Duiverman EJ Bos AF Reijneveld SA
Meta-analysis of adjusted dosendashresponse association between gestational age (per week increase) and childhood wheezing disorders
Been JV Lugtenberg MJ Smets E van Schayck CP et al (2014) Preterm Birth and Childhood Wheezing Disorders A Systematic Review and Meta-Analysis PLoS Med 11(1) e1001596 doi101371journalpmed1001596 httpwwwplosmedicineorgarticleinfodoi101371journalpmed1001596
bull 1-14 years bull Apr 1 milj
2014-09-20
5
They conclude prematurity and wheeze bull OR 171 bull 137 lt 37 weeks vs 83 term Sub group analysis bull Very and extrem (lt 32 weeks) OR 30
bull Moderate-to-late preterm (32-36) OR 149
bull Every week 6 less risk of wheeze
Impaired lung function and health status in adult survivors of bronchopulmonary dysplasia Gough et al ERJ 2014
bull Mean age 24 bull Only small differences BPD (27 weeks) vs non BPD (31 weeks) bull Significant morbidity among BPD survivors
Stocks Hislop Sonnappa 2013
bull Surfactant pool increases bull Increased numbers of alveoli (dependent on elastin smooth
muscle capillary network) bull Inceased gas exchange surface (thinning of insterstial tissue)
Lung development during late Saccular and Alveolar period
2014-09-20
6
Prenatal factors
Airway and lung development are ldquoprogrammedrdquo before birth
(Barker BMJ 1991303)
bull Genes genpolymorfism epigenetics sex
bull Prenatal under nutrition birth weight
bull Exposions infections maternal smooking
bull Prematurity stage
Airway obstruction in Bronchopulmonal dysplasia BPD
Baraldi et Filippone N Eng J 2008
bull 8839 titles bull 59 studies preterm (lt 37 weeks) vs term
bull Born 1964 to 2000
bull 5-23 years
bull FEV1 procent predicted
2014-09-20
7
Lower lung function in no-BPD - 72 FEV1
Impaired lung function and health status in adult survivors of bronchopulmonary dysplasia Gough et al ERJ 2014
bull Non BPD ( mean 31 weeks) significantly lower lung function at 24 years
bull 30-34 week + controlls
bull Test 1 10 weeks bull Test 2 15 months
Growth rate of lung function i healthy preterm infants Friedrich et all Am J Crit Care 2007176
bull Tracking of lung function in infancy av moderate-to-late preterm birth
2014-09-20
8
Effect of late preterm birth on longitudinal lung spirometry in school age children and adolecents Kotecha S et al Thorax 201267
bull Lung function at 8-9 years lower after preterm birth 33-34 weeks of gestation bull No difference for 35-36 weeks compared to term
8-9 year follow-up
bull Increase in lung function from 8 to 17 years in 32-34 week of gestation- rdquocatch up growthrdquo
Effect of late preterm birth on longitudinal lung spirometry in school age children and adolecents Kotecha S et al Thorax 201267
14-17 year follow-up
Figure 2 Maximal exercise capacity Adjusted results expressed as least squared means for maximal exercise capacity (Watt) in relation to the major risk factors A - Gestational Age categories
Long-Term Impact of Preterm Birth on Exercise Capacity in Healthy Young Men A National Population-Based Cohort Study Jenny Svedenkrans12 Ewa Henckel12 Jan Kowalski1 Mikael Norman12 Kajsa Bohlin12
Exercise capacity after preterm birth is reduced
2014-09-20
9
Lung function at age 8 and 16 years after moderate-to-late preterm birth - a prospective cohort study Per Thunqvist12 Per M Gustafsson34 Erica S Schultz5 Tom Bellander56 Eva Berggren-Brostroumlm12 Mikael Norman7 Magnus Wickman15 Erik Meleacuten15 Jenny Hallberg15 Submitted
Diff 95 CI p-value
8 years (n=89)
FEV05 (ml) -508 -866-149 0005
FEV1 (ml) -291 -685103 0148
MEF50 (mls) -1537 -2669-405 0008
FVC (ml) -52 -504399 0821
FEV1FVC ( units) -13 -25-01 0027
16 years (n=107)
FEV05 (ml) -1267 -1985-548 0001
FEV1 (ml) -1202 -2072-331 0007
MEF50 (mls) -3931 -6070-1792 lt0001
FVC (ml) -209 -1199781 0679
FEV1FVC ( units) -24 -36-11 lt0001
Differences in lung function between term children and the moderate-to-late preterm group at 8 and 16 years of age term vs 32-36 weeks
bull Flows low bull Volume normal
Spirometric variables expressed as mean Z-scores and 95 confidence intervals for at 8 and 16 years of age for term and moderate-to-late preterm children
bull No catch up from 8 to 16 years of age
bull Instead augmented between age 8 and 16 years
2014-09-20
10
Diff 95 CI p-value
Spirometry at 8 years
(n=73)
FEV05 (ml) -458 -851-65 0022
FEV1 (ml) -288 -722146 0193
MEF50 (mls) -1665 -2911-419 0009
FVC (ml) -58 -555439 0818
FEV1FVC ( units) -12 -25005 0060
Spirometry at 16 years
(n=84)
FEV05 (ml) -1266 -2077-459 0002
FEV1 (ml) -1120 -2176-223 0016
MEF50 (mls) -4604 -7003-2205 lt0001
FVC (ml) 171 -9401282 0763
FEV1FVC ( units) -31 -45-17 lt0001
Differences in lung function between term children and the moderate-to-late preterm group at 8 and 16 years of age term vs 35-36 weeks
bull rdquosamerdquo differences for 35-36 weeks
ERS 2014
In conclusion
bull Preterm birth is common and particuarly moderate-to prematur birth
bull Perinatal mortality and morbidity is high after moderate-to-late preterm birth bull Respiratory morbidity continues to be higher during preschool age and
probably even in adulthood among former moderate-to-late preterm subjects
bull Lower lung function is found in infancy school age and adolecents after moderate-to-late preterm birth
bull This large group of individuals that do not reach maximal lung function peak could be at risk of future respiratory morbidity including COPD
2014-09-20
4
Fig 1 Respiratory morbidity in late preterm births ltceinline-figure baseline=00gt
Sarah J Kotecha Frank D Dunstan Sailesh Kotecha
Long term respiratory outcomes of late preterm-born infants
Seminars in Fetal and Neonatal Medicine Volume 17 Issue 2 2012 77 - 81
Respiratory perinatal morbidity
Moderately preterm children have more respiratory problems during their first 5 years of life than children born full term Vrijlandt EJ1 Kerstjens JM Duiverman EJ Bos AF Reijneveld SA
Meta-analysis of adjusted dosendashresponse association between gestational age (per week increase) and childhood wheezing disorders
Been JV Lugtenberg MJ Smets E van Schayck CP et al (2014) Preterm Birth and Childhood Wheezing Disorders A Systematic Review and Meta-Analysis PLoS Med 11(1) e1001596 doi101371journalpmed1001596 httpwwwplosmedicineorgarticleinfodoi101371journalpmed1001596
bull 1-14 years bull Apr 1 milj
2014-09-20
5
They conclude prematurity and wheeze bull OR 171 bull 137 lt 37 weeks vs 83 term Sub group analysis bull Very and extrem (lt 32 weeks) OR 30
bull Moderate-to-late preterm (32-36) OR 149
bull Every week 6 less risk of wheeze
Impaired lung function and health status in adult survivors of bronchopulmonary dysplasia Gough et al ERJ 2014
bull Mean age 24 bull Only small differences BPD (27 weeks) vs non BPD (31 weeks) bull Significant morbidity among BPD survivors
Stocks Hislop Sonnappa 2013
bull Surfactant pool increases bull Increased numbers of alveoli (dependent on elastin smooth
muscle capillary network) bull Inceased gas exchange surface (thinning of insterstial tissue)
Lung development during late Saccular and Alveolar period
2014-09-20
6
Prenatal factors
Airway and lung development are ldquoprogrammedrdquo before birth
(Barker BMJ 1991303)
bull Genes genpolymorfism epigenetics sex
bull Prenatal under nutrition birth weight
bull Exposions infections maternal smooking
bull Prematurity stage
Airway obstruction in Bronchopulmonal dysplasia BPD
Baraldi et Filippone N Eng J 2008
bull 8839 titles bull 59 studies preterm (lt 37 weeks) vs term
bull Born 1964 to 2000
bull 5-23 years
bull FEV1 procent predicted
2014-09-20
7
Lower lung function in no-BPD - 72 FEV1
Impaired lung function and health status in adult survivors of bronchopulmonary dysplasia Gough et al ERJ 2014
bull Non BPD ( mean 31 weeks) significantly lower lung function at 24 years
bull 30-34 week + controlls
bull Test 1 10 weeks bull Test 2 15 months
Growth rate of lung function i healthy preterm infants Friedrich et all Am J Crit Care 2007176
bull Tracking of lung function in infancy av moderate-to-late preterm birth
2014-09-20
8
Effect of late preterm birth on longitudinal lung spirometry in school age children and adolecents Kotecha S et al Thorax 201267
bull Lung function at 8-9 years lower after preterm birth 33-34 weeks of gestation bull No difference for 35-36 weeks compared to term
8-9 year follow-up
bull Increase in lung function from 8 to 17 years in 32-34 week of gestation- rdquocatch up growthrdquo
Effect of late preterm birth on longitudinal lung spirometry in school age children and adolecents Kotecha S et al Thorax 201267
14-17 year follow-up
Figure 2 Maximal exercise capacity Adjusted results expressed as least squared means for maximal exercise capacity (Watt) in relation to the major risk factors A - Gestational Age categories
Long-Term Impact of Preterm Birth on Exercise Capacity in Healthy Young Men A National Population-Based Cohort Study Jenny Svedenkrans12 Ewa Henckel12 Jan Kowalski1 Mikael Norman12 Kajsa Bohlin12
Exercise capacity after preterm birth is reduced
2014-09-20
9
Lung function at age 8 and 16 years after moderate-to-late preterm birth - a prospective cohort study Per Thunqvist12 Per M Gustafsson34 Erica S Schultz5 Tom Bellander56 Eva Berggren-Brostroumlm12 Mikael Norman7 Magnus Wickman15 Erik Meleacuten15 Jenny Hallberg15 Submitted
Diff 95 CI p-value
8 years (n=89)
FEV05 (ml) -508 -866-149 0005
FEV1 (ml) -291 -685103 0148
MEF50 (mls) -1537 -2669-405 0008
FVC (ml) -52 -504399 0821
FEV1FVC ( units) -13 -25-01 0027
16 years (n=107)
FEV05 (ml) -1267 -1985-548 0001
FEV1 (ml) -1202 -2072-331 0007
MEF50 (mls) -3931 -6070-1792 lt0001
FVC (ml) -209 -1199781 0679
FEV1FVC ( units) -24 -36-11 lt0001
Differences in lung function between term children and the moderate-to-late preterm group at 8 and 16 years of age term vs 32-36 weeks
bull Flows low bull Volume normal
Spirometric variables expressed as mean Z-scores and 95 confidence intervals for at 8 and 16 years of age for term and moderate-to-late preterm children
bull No catch up from 8 to 16 years of age
bull Instead augmented between age 8 and 16 years
2014-09-20
10
Diff 95 CI p-value
Spirometry at 8 years
(n=73)
FEV05 (ml) -458 -851-65 0022
FEV1 (ml) -288 -722146 0193
MEF50 (mls) -1665 -2911-419 0009
FVC (ml) -58 -555439 0818
FEV1FVC ( units) -12 -25005 0060
Spirometry at 16 years
(n=84)
FEV05 (ml) -1266 -2077-459 0002
FEV1 (ml) -1120 -2176-223 0016
MEF50 (mls) -4604 -7003-2205 lt0001
FVC (ml) 171 -9401282 0763
FEV1FVC ( units) -31 -45-17 lt0001
Differences in lung function between term children and the moderate-to-late preterm group at 8 and 16 years of age term vs 35-36 weeks
bull rdquosamerdquo differences for 35-36 weeks
ERS 2014
In conclusion
bull Preterm birth is common and particuarly moderate-to prematur birth
bull Perinatal mortality and morbidity is high after moderate-to-late preterm birth bull Respiratory morbidity continues to be higher during preschool age and
probably even in adulthood among former moderate-to-late preterm subjects
bull Lower lung function is found in infancy school age and adolecents after moderate-to-late preterm birth
bull This large group of individuals that do not reach maximal lung function peak could be at risk of future respiratory morbidity including COPD
2014-09-20
5
They conclude prematurity and wheeze bull OR 171 bull 137 lt 37 weeks vs 83 term Sub group analysis bull Very and extrem (lt 32 weeks) OR 30
bull Moderate-to-late preterm (32-36) OR 149
bull Every week 6 less risk of wheeze
Impaired lung function and health status in adult survivors of bronchopulmonary dysplasia Gough et al ERJ 2014
bull Mean age 24 bull Only small differences BPD (27 weeks) vs non BPD (31 weeks) bull Significant morbidity among BPD survivors
Stocks Hislop Sonnappa 2013
bull Surfactant pool increases bull Increased numbers of alveoli (dependent on elastin smooth
muscle capillary network) bull Inceased gas exchange surface (thinning of insterstial tissue)
Lung development during late Saccular and Alveolar period
2014-09-20
6
Prenatal factors
Airway and lung development are ldquoprogrammedrdquo before birth
(Barker BMJ 1991303)
bull Genes genpolymorfism epigenetics sex
bull Prenatal under nutrition birth weight
bull Exposions infections maternal smooking
bull Prematurity stage
Airway obstruction in Bronchopulmonal dysplasia BPD
Baraldi et Filippone N Eng J 2008
bull 8839 titles bull 59 studies preterm (lt 37 weeks) vs term
bull Born 1964 to 2000
bull 5-23 years
bull FEV1 procent predicted
2014-09-20
7
Lower lung function in no-BPD - 72 FEV1
Impaired lung function and health status in adult survivors of bronchopulmonary dysplasia Gough et al ERJ 2014
bull Non BPD ( mean 31 weeks) significantly lower lung function at 24 years
bull 30-34 week + controlls
bull Test 1 10 weeks bull Test 2 15 months
Growth rate of lung function i healthy preterm infants Friedrich et all Am J Crit Care 2007176
bull Tracking of lung function in infancy av moderate-to-late preterm birth
2014-09-20
8
Effect of late preterm birth on longitudinal lung spirometry in school age children and adolecents Kotecha S et al Thorax 201267
bull Lung function at 8-9 years lower after preterm birth 33-34 weeks of gestation bull No difference for 35-36 weeks compared to term
8-9 year follow-up
bull Increase in lung function from 8 to 17 years in 32-34 week of gestation- rdquocatch up growthrdquo
Effect of late preterm birth on longitudinal lung spirometry in school age children and adolecents Kotecha S et al Thorax 201267
14-17 year follow-up
Figure 2 Maximal exercise capacity Adjusted results expressed as least squared means for maximal exercise capacity (Watt) in relation to the major risk factors A - Gestational Age categories
Long-Term Impact of Preterm Birth on Exercise Capacity in Healthy Young Men A National Population-Based Cohort Study Jenny Svedenkrans12 Ewa Henckel12 Jan Kowalski1 Mikael Norman12 Kajsa Bohlin12
Exercise capacity after preterm birth is reduced
2014-09-20
9
Lung function at age 8 and 16 years after moderate-to-late preterm birth - a prospective cohort study Per Thunqvist12 Per M Gustafsson34 Erica S Schultz5 Tom Bellander56 Eva Berggren-Brostroumlm12 Mikael Norman7 Magnus Wickman15 Erik Meleacuten15 Jenny Hallberg15 Submitted
Diff 95 CI p-value
8 years (n=89)
FEV05 (ml) -508 -866-149 0005
FEV1 (ml) -291 -685103 0148
MEF50 (mls) -1537 -2669-405 0008
FVC (ml) -52 -504399 0821
FEV1FVC ( units) -13 -25-01 0027
16 years (n=107)
FEV05 (ml) -1267 -1985-548 0001
FEV1 (ml) -1202 -2072-331 0007
MEF50 (mls) -3931 -6070-1792 lt0001
FVC (ml) -209 -1199781 0679
FEV1FVC ( units) -24 -36-11 lt0001
Differences in lung function between term children and the moderate-to-late preterm group at 8 and 16 years of age term vs 32-36 weeks
bull Flows low bull Volume normal
Spirometric variables expressed as mean Z-scores and 95 confidence intervals for at 8 and 16 years of age for term and moderate-to-late preterm children
bull No catch up from 8 to 16 years of age
bull Instead augmented between age 8 and 16 years
2014-09-20
10
Diff 95 CI p-value
Spirometry at 8 years
(n=73)
FEV05 (ml) -458 -851-65 0022
FEV1 (ml) -288 -722146 0193
MEF50 (mls) -1665 -2911-419 0009
FVC (ml) -58 -555439 0818
FEV1FVC ( units) -12 -25005 0060
Spirometry at 16 years
(n=84)
FEV05 (ml) -1266 -2077-459 0002
FEV1 (ml) -1120 -2176-223 0016
MEF50 (mls) -4604 -7003-2205 lt0001
FVC (ml) 171 -9401282 0763
FEV1FVC ( units) -31 -45-17 lt0001
Differences in lung function between term children and the moderate-to-late preterm group at 8 and 16 years of age term vs 35-36 weeks
bull rdquosamerdquo differences for 35-36 weeks
ERS 2014
In conclusion
bull Preterm birth is common and particuarly moderate-to prematur birth
bull Perinatal mortality and morbidity is high after moderate-to-late preterm birth bull Respiratory morbidity continues to be higher during preschool age and
probably even in adulthood among former moderate-to-late preterm subjects
bull Lower lung function is found in infancy school age and adolecents after moderate-to-late preterm birth
bull This large group of individuals that do not reach maximal lung function peak could be at risk of future respiratory morbidity including COPD
2014-09-20
6
Prenatal factors
Airway and lung development are ldquoprogrammedrdquo before birth
(Barker BMJ 1991303)
bull Genes genpolymorfism epigenetics sex
bull Prenatal under nutrition birth weight
bull Exposions infections maternal smooking
bull Prematurity stage
Airway obstruction in Bronchopulmonal dysplasia BPD
Baraldi et Filippone N Eng J 2008
bull 8839 titles bull 59 studies preterm (lt 37 weeks) vs term
bull Born 1964 to 2000
bull 5-23 years
bull FEV1 procent predicted
2014-09-20
7
Lower lung function in no-BPD - 72 FEV1
Impaired lung function and health status in adult survivors of bronchopulmonary dysplasia Gough et al ERJ 2014
bull Non BPD ( mean 31 weeks) significantly lower lung function at 24 years
bull 30-34 week + controlls
bull Test 1 10 weeks bull Test 2 15 months
Growth rate of lung function i healthy preterm infants Friedrich et all Am J Crit Care 2007176
bull Tracking of lung function in infancy av moderate-to-late preterm birth
2014-09-20
8
Effect of late preterm birth on longitudinal lung spirometry in school age children and adolecents Kotecha S et al Thorax 201267
bull Lung function at 8-9 years lower after preterm birth 33-34 weeks of gestation bull No difference for 35-36 weeks compared to term
8-9 year follow-up
bull Increase in lung function from 8 to 17 years in 32-34 week of gestation- rdquocatch up growthrdquo
Effect of late preterm birth on longitudinal lung spirometry in school age children and adolecents Kotecha S et al Thorax 201267
14-17 year follow-up
Figure 2 Maximal exercise capacity Adjusted results expressed as least squared means for maximal exercise capacity (Watt) in relation to the major risk factors A - Gestational Age categories
Long-Term Impact of Preterm Birth on Exercise Capacity in Healthy Young Men A National Population-Based Cohort Study Jenny Svedenkrans12 Ewa Henckel12 Jan Kowalski1 Mikael Norman12 Kajsa Bohlin12
Exercise capacity after preterm birth is reduced
2014-09-20
9
Lung function at age 8 and 16 years after moderate-to-late preterm birth - a prospective cohort study Per Thunqvist12 Per M Gustafsson34 Erica S Schultz5 Tom Bellander56 Eva Berggren-Brostroumlm12 Mikael Norman7 Magnus Wickman15 Erik Meleacuten15 Jenny Hallberg15 Submitted
Diff 95 CI p-value
8 years (n=89)
FEV05 (ml) -508 -866-149 0005
FEV1 (ml) -291 -685103 0148
MEF50 (mls) -1537 -2669-405 0008
FVC (ml) -52 -504399 0821
FEV1FVC ( units) -13 -25-01 0027
16 years (n=107)
FEV05 (ml) -1267 -1985-548 0001
FEV1 (ml) -1202 -2072-331 0007
MEF50 (mls) -3931 -6070-1792 lt0001
FVC (ml) -209 -1199781 0679
FEV1FVC ( units) -24 -36-11 lt0001
Differences in lung function between term children and the moderate-to-late preterm group at 8 and 16 years of age term vs 32-36 weeks
bull Flows low bull Volume normal
Spirometric variables expressed as mean Z-scores and 95 confidence intervals for at 8 and 16 years of age for term and moderate-to-late preterm children
bull No catch up from 8 to 16 years of age
bull Instead augmented between age 8 and 16 years
2014-09-20
10
Diff 95 CI p-value
Spirometry at 8 years
(n=73)
FEV05 (ml) -458 -851-65 0022
FEV1 (ml) -288 -722146 0193
MEF50 (mls) -1665 -2911-419 0009
FVC (ml) -58 -555439 0818
FEV1FVC ( units) -12 -25005 0060
Spirometry at 16 years
(n=84)
FEV05 (ml) -1266 -2077-459 0002
FEV1 (ml) -1120 -2176-223 0016
MEF50 (mls) -4604 -7003-2205 lt0001
FVC (ml) 171 -9401282 0763
FEV1FVC ( units) -31 -45-17 lt0001
Differences in lung function between term children and the moderate-to-late preterm group at 8 and 16 years of age term vs 35-36 weeks
bull rdquosamerdquo differences for 35-36 weeks
ERS 2014
In conclusion
bull Preterm birth is common and particuarly moderate-to prematur birth
bull Perinatal mortality and morbidity is high after moderate-to-late preterm birth bull Respiratory morbidity continues to be higher during preschool age and
probably even in adulthood among former moderate-to-late preterm subjects
bull Lower lung function is found in infancy school age and adolecents after moderate-to-late preterm birth
bull This large group of individuals that do not reach maximal lung function peak could be at risk of future respiratory morbidity including COPD
2014-09-20
7
Lower lung function in no-BPD - 72 FEV1
Impaired lung function and health status in adult survivors of bronchopulmonary dysplasia Gough et al ERJ 2014
bull Non BPD ( mean 31 weeks) significantly lower lung function at 24 years
bull 30-34 week + controlls
bull Test 1 10 weeks bull Test 2 15 months
Growth rate of lung function i healthy preterm infants Friedrich et all Am J Crit Care 2007176
bull Tracking of lung function in infancy av moderate-to-late preterm birth
2014-09-20
8
Effect of late preterm birth on longitudinal lung spirometry in school age children and adolecents Kotecha S et al Thorax 201267
bull Lung function at 8-9 years lower after preterm birth 33-34 weeks of gestation bull No difference for 35-36 weeks compared to term
8-9 year follow-up
bull Increase in lung function from 8 to 17 years in 32-34 week of gestation- rdquocatch up growthrdquo
Effect of late preterm birth on longitudinal lung spirometry in school age children and adolecents Kotecha S et al Thorax 201267
14-17 year follow-up
Figure 2 Maximal exercise capacity Adjusted results expressed as least squared means for maximal exercise capacity (Watt) in relation to the major risk factors A - Gestational Age categories
Long-Term Impact of Preterm Birth on Exercise Capacity in Healthy Young Men A National Population-Based Cohort Study Jenny Svedenkrans12 Ewa Henckel12 Jan Kowalski1 Mikael Norman12 Kajsa Bohlin12
Exercise capacity after preterm birth is reduced
2014-09-20
9
Lung function at age 8 and 16 years after moderate-to-late preterm birth - a prospective cohort study Per Thunqvist12 Per M Gustafsson34 Erica S Schultz5 Tom Bellander56 Eva Berggren-Brostroumlm12 Mikael Norman7 Magnus Wickman15 Erik Meleacuten15 Jenny Hallberg15 Submitted
Diff 95 CI p-value
8 years (n=89)
FEV05 (ml) -508 -866-149 0005
FEV1 (ml) -291 -685103 0148
MEF50 (mls) -1537 -2669-405 0008
FVC (ml) -52 -504399 0821
FEV1FVC ( units) -13 -25-01 0027
16 years (n=107)
FEV05 (ml) -1267 -1985-548 0001
FEV1 (ml) -1202 -2072-331 0007
MEF50 (mls) -3931 -6070-1792 lt0001
FVC (ml) -209 -1199781 0679
FEV1FVC ( units) -24 -36-11 lt0001
Differences in lung function between term children and the moderate-to-late preterm group at 8 and 16 years of age term vs 32-36 weeks
bull Flows low bull Volume normal
Spirometric variables expressed as mean Z-scores and 95 confidence intervals for at 8 and 16 years of age for term and moderate-to-late preterm children
bull No catch up from 8 to 16 years of age
bull Instead augmented between age 8 and 16 years
2014-09-20
10
Diff 95 CI p-value
Spirometry at 8 years
(n=73)
FEV05 (ml) -458 -851-65 0022
FEV1 (ml) -288 -722146 0193
MEF50 (mls) -1665 -2911-419 0009
FVC (ml) -58 -555439 0818
FEV1FVC ( units) -12 -25005 0060
Spirometry at 16 years
(n=84)
FEV05 (ml) -1266 -2077-459 0002
FEV1 (ml) -1120 -2176-223 0016
MEF50 (mls) -4604 -7003-2205 lt0001
FVC (ml) 171 -9401282 0763
FEV1FVC ( units) -31 -45-17 lt0001
Differences in lung function between term children and the moderate-to-late preterm group at 8 and 16 years of age term vs 35-36 weeks
bull rdquosamerdquo differences for 35-36 weeks
ERS 2014
In conclusion
bull Preterm birth is common and particuarly moderate-to prematur birth
bull Perinatal mortality and morbidity is high after moderate-to-late preterm birth bull Respiratory morbidity continues to be higher during preschool age and
probably even in adulthood among former moderate-to-late preterm subjects
bull Lower lung function is found in infancy school age and adolecents after moderate-to-late preterm birth
bull This large group of individuals that do not reach maximal lung function peak could be at risk of future respiratory morbidity including COPD
2014-09-20
8
Effect of late preterm birth on longitudinal lung spirometry in school age children and adolecents Kotecha S et al Thorax 201267
bull Lung function at 8-9 years lower after preterm birth 33-34 weeks of gestation bull No difference for 35-36 weeks compared to term
8-9 year follow-up
bull Increase in lung function from 8 to 17 years in 32-34 week of gestation- rdquocatch up growthrdquo
Effect of late preterm birth on longitudinal lung spirometry in school age children and adolecents Kotecha S et al Thorax 201267
14-17 year follow-up
Figure 2 Maximal exercise capacity Adjusted results expressed as least squared means for maximal exercise capacity (Watt) in relation to the major risk factors A - Gestational Age categories
Long-Term Impact of Preterm Birth on Exercise Capacity in Healthy Young Men A National Population-Based Cohort Study Jenny Svedenkrans12 Ewa Henckel12 Jan Kowalski1 Mikael Norman12 Kajsa Bohlin12
Exercise capacity after preterm birth is reduced
2014-09-20
9
Lung function at age 8 and 16 years after moderate-to-late preterm birth - a prospective cohort study Per Thunqvist12 Per M Gustafsson34 Erica S Schultz5 Tom Bellander56 Eva Berggren-Brostroumlm12 Mikael Norman7 Magnus Wickman15 Erik Meleacuten15 Jenny Hallberg15 Submitted
Diff 95 CI p-value
8 years (n=89)
FEV05 (ml) -508 -866-149 0005
FEV1 (ml) -291 -685103 0148
MEF50 (mls) -1537 -2669-405 0008
FVC (ml) -52 -504399 0821
FEV1FVC ( units) -13 -25-01 0027
16 years (n=107)
FEV05 (ml) -1267 -1985-548 0001
FEV1 (ml) -1202 -2072-331 0007
MEF50 (mls) -3931 -6070-1792 lt0001
FVC (ml) -209 -1199781 0679
FEV1FVC ( units) -24 -36-11 lt0001
Differences in lung function between term children and the moderate-to-late preterm group at 8 and 16 years of age term vs 32-36 weeks
bull Flows low bull Volume normal
Spirometric variables expressed as mean Z-scores and 95 confidence intervals for at 8 and 16 years of age for term and moderate-to-late preterm children
bull No catch up from 8 to 16 years of age
bull Instead augmented between age 8 and 16 years
2014-09-20
10
Diff 95 CI p-value
Spirometry at 8 years
(n=73)
FEV05 (ml) -458 -851-65 0022
FEV1 (ml) -288 -722146 0193
MEF50 (mls) -1665 -2911-419 0009
FVC (ml) -58 -555439 0818
FEV1FVC ( units) -12 -25005 0060
Spirometry at 16 years
(n=84)
FEV05 (ml) -1266 -2077-459 0002
FEV1 (ml) -1120 -2176-223 0016
MEF50 (mls) -4604 -7003-2205 lt0001
FVC (ml) 171 -9401282 0763
FEV1FVC ( units) -31 -45-17 lt0001
Differences in lung function between term children and the moderate-to-late preterm group at 8 and 16 years of age term vs 35-36 weeks
bull rdquosamerdquo differences for 35-36 weeks
ERS 2014
In conclusion
bull Preterm birth is common and particuarly moderate-to prematur birth
bull Perinatal mortality and morbidity is high after moderate-to-late preterm birth bull Respiratory morbidity continues to be higher during preschool age and
probably even in adulthood among former moderate-to-late preterm subjects
bull Lower lung function is found in infancy school age and adolecents after moderate-to-late preterm birth
bull This large group of individuals that do not reach maximal lung function peak could be at risk of future respiratory morbidity including COPD
2014-09-20
9
Lung function at age 8 and 16 years after moderate-to-late preterm birth - a prospective cohort study Per Thunqvist12 Per M Gustafsson34 Erica S Schultz5 Tom Bellander56 Eva Berggren-Brostroumlm12 Mikael Norman7 Magnus Wickman15 Erik Meleacuten15 Jenny Hallberg15 Submitted
Diff 95 CI p-value
8 years (n=89)
FEV05 (ml) -508 -866-149 0005
FEV1 (ml) -291 -685103 0148
MEF50 (mls) -1537 -2669-405 0008
FVC (ml) -52 -504399 0821
FEV1FVC ( units) -13 -25-01 0027
16 years (n=107)
FEV05 (ml) -1267 -1985-548 0001
FEV1 (ml) -1202 -2072-331 0007
MEF50 (mls) -3931 -6070-1792 lt0001
FVC (ml) -209 -1199781 0679
FEV1FVC ( units) -24 -36-11 lt0001
Differences in lung function between term children and the moderate-to-late preterm group at 8 and 16 years of age term vs 32-36 weeks
bull Flows low bull Volume normal
Spirometric variables expressed as mean Z-scores and 95 confidence intervals for at 8 and 16 years of age for term and moderate-to-late preterm children
bull No catch up from 8 to 16 years of age
bull Instead augmented between age 8 and 16 years
2014-09-20
10
Diff 95 CI p-value
Spirometry at 8 years
(n=73)
FEV05 (ml) -458 -851-65 0022
FEV1 (ml) -288 -722146 0193
MEF50 (mls) -1665 -2911-419 0009
FVC (ml) -58 -555439 0818
FEV1FVC ( units) -12 -25005 0060
Spirometry at 16 years
(n=84)
FEV05 (ml) -1266 -2077-459 0002
FEV1 (ml) -1120 -2176-223 0016
MEF50 (mls) -4604 -7003-2205 lt0001
FVC (ml) 171 -9401282 0763
FEV1FVC ( units) -31 -45-17 lt0001
Differences in lung function between term children and the moderate-to-late preterm group at 8 and 16 years of age term vs 35-36 weeks
bull rdquosamerdquo differences for 35-36 weeks
ERS 2014
In conclusion
bull Preterm birth is common and particuarly moderate-to prematur birth
bull Perinatal mortality and morbidity is high after moderate-to-late preterm birth bull Respiratory morbidity continues to be higher during preschool age and
probably even in adulthood among former moderate-to-late preterm subjects
bull Lower lung function is found in infancy school age and adolecents after moderate-to-late preterm birth
bull This large group of individuals that do not reach maximal lung function peak could be at risk of future respiratory morbidity including COPD
2014-09-20
10
Diff 95 CI p-value
Spirometry at 8 years
(n=73)
FEV05 (ml) -458 -851-65 0022
FEV1 (ml) -288 -722146 0193
MEF50 (mls) -1665 -2911-419 0009
FVC (ml) -58 -555439 0818
FEV1FVC ( units) -12 -25005 0060
Spirometry at 16 years
(n=84)
FEV05 (ml) -1266 -2077-459 0002
FEV1 (ml) -1120 -2176-223 0016
MEF50 (mls) -4604 -7003-2205 lt0001
FVC (ml) 171 -9401282 0763
FEV1FVC ( units) -31 -45-17 lt0001
Differences in lung function between term children and the moderate-to-late preterm group at 8 and 16 years of age term vs 35-36 weeks
bull rdquosamerdquo differences for 35-36 weeks
ERS 2014
In conclusion
bull Preterm birth is common and particuarly moderate-to prematur birth
bull Perinatal mortality and morbidity is high after moderate-to-late preterm birth bull Respiratory morbidity continues to be higher during preschool age and
probably even in adulthood among former moderate-to-late preterm subjects
bull Lower lung function is found in infancy school age and adolecents after moderate-to-late preterm birth
bull This large group of individuals that do not reach maximal lung function peak could be at risk of future respiratory morbidity including COPD