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Development of lung diffusion to adulthood following extremely preterm birth.

Authors :: Satrell E
Clemm H
Røksund OD
Hufthammer KO
Thorsen E
Halvorsen T
Vollsæter M
Source :: The European respiratory journal [Eur Respir J] 2022 May 19; Vol. 59 (5). Date of Electronic Publication: 2022 May 19 (Print Publication: 2022).
Publication Year :: 2022
Abstract: Background: Gas exchange in extremely preterm (EP) infants must take place in fetal lungs. Childhood lung diffusing capacity of the lung for carbon monoxide ( D <subscript>LCO</subscript> ) is reduced; however, longitudinal development has not been investigated. We describe the growth of D <subscript>LCO</subscript> and its subcomponents to adulthood in EP compared with term-born subjects. Methods: Two area-based cohorts born at gestational age ≤28 weeks or birthweight ≤1000 g in 1982-1985 (n=48) and 1991-1992 (n=35) were examined twice, at ages 18 and 25 years and 10 and 18 years, respectively, and compared with matched term-born controls. Single-breath D <subscript>LCO</subscript> was measured at two oxygen pressures, with subcomponents (membrane diffusion ( D <subscript>M</subscript> ) and pulmonary capillary blood volume ( V <subscript>C</subscript> )) calculated using the Roughton-Forster equation. Results: Age-, sex- and height-standardised transfer coefficients for carbon monoxide ( K <subscript>CO</subscript> ) and D <subscript>LCO</subscript> were reduced in EP compared with term-born subjects, and remained so during puberty and early adulthood (p-values for all time-points and both cohorts ≤0.04), whereas alveolar volume ( V <subscript>A</subscript> ) was similar. Development occurred in parallel to term-born controls, with no signs of pubertal catch-up growth nor decline at age 25 years (p-values for lack of parallelism within cohorts 0.99, 0.65, 0.71, 0.94 and 0.44 for z- D <subscript>LCO</subscript> , z- V <subscript>A</subscript> , z- K <subscript>CO</subscript> , D <subscript>M</subscript> and V <subscript>C</subscript> , respectively). Split by membrane and blood volume components, findings were less clear; however, membrane diffusion seemed most affected. Conclusions: Pulmonary diffusing capacity was reduced in EP compared with term-born subjects, and development from childhood to adulthood tracked in parallel to term-born subjects, with no signs of catch-up growth nor decline at age 25 years. Competing Interests: Conflict of interest: E. Satrell has nothing to disclose. Conflict of interest: H. Clemm has nothing to disclose. Conflict of interest: O.D. Røksund has nothing to disclose. Conflict of interest: K.O. Hufthammer has nothing to disclose. Conflict of interest: E. Thorsen has nothing to disclose. Conflict of interest: T. Halvorsen has nothing to disclose. Conflict of interest: M. Vollsæter has nothing to disclose. (Copyright ©The authors 2022.)