title: Fetal growth restriction and chronic lung disease among infants born before the 28th week of gestation.
abstract: OBJECTIVE
  Improvement in survival of extremely premature infants over the past several decades has resulted in an increase in the number of infants with chronic lung disease (CLD). Historical neonatal exposures associated with CLD now less frequently precede the disease. There is now increasing interest in exposures and events before delivery that predict CLD. The objective of this study was to identify current prenatal predictors of CLD.
  
  
  METHODS
  We collected data about prenatal, placental, and neonatal characteristics of 1241 newborns who were delivered before completion of the 28th week of gestation. Associations between prenatal factors, microbiologic and histologic characteristics of the placenta, and selected neonatal characteristics and CLD risk were first evaluated in univariate analyses. Subsequent multivariate analyses investigated the contribution of prenatal factors, particularly fetal growth restriction (FGR), to CLD risk.
  
  
  RESULTS
  Among the prenatal factors, birth weight z scores, used as a marker of FGR, provided the most information about CLD risk. Indicators of placental inflammation and infection were not associated with increased risk of CLD. Within nearly all strata of prenatal, placental, and neonatal variables, growth-restricted infants were at increased CLD risk, compared with infants who were not growth-restricted. FGR was the only maternal or prenatal characteristic that was highly predictive of CLD after adjustment for other risk factors.
  
  
  CONCLUSIONS
  FGR is independently associated with the risk of CLD. Thus, factors that control fetal somatic growth may have a significant impact on vulnerability to lung injury and in this way increase CLD risk.
authors.affiliation: Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. cbose@med.unc.edu
authors.forename: Carl
authors.initials: C
authors.lastname: Bose
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Van Marter
authors.forename: Matthew
authors.initials: M
authors.lastname: Laughon
authors.forename: T Michael
authors.initials: TM
authors.lastname: O'Shea
authors.forename: Elizabeth N
authors.initials: EN
authors.lastname: Allred
authors.forename: Padmani
authors.initials: P
authors.lastname: Karna
authors.forename: Richard A
authors.initials: RA
authors.lastname: Ehrenkranz
authors.forename: Kim
authors.initials: K
authors.lastname: Boggess
authors.forename: Alan
authors.initials: A
authors.lastname: Leviton
mesh_terms: D002908:Chronic Disease; D005260:Female; D005317:Fetal Growth Retardation; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000209:etiology*; D008171:Lung Diseases / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D012307:Risk Factors
references.citation: Pediatrics. 2008 Sep;122(3):e662-9
references.pmid: 18762501
references.citation: Biol Neonate. 2004;86(2):124-30
references.pmid: 15192303
references.citation: N Engl J Med. 1967 Feb 16;276(7):357-68
references.pmid: 5334613
references.citation: Pediatr Res. 2004 Jun;55(6):1009-17
references.pmid: 15155869
references.citation: Am J Physiol Lung Cell Mol Physiol. 2008 Jul;295(1):L86-95
references.pmid: 18487357
references.citation: Hum Pathol. 2001 Jun;32(6):623-9
references.pmid: 11431717
references.citation: Pediatrics. 2008 Aug;122(2):340-6
references.pmid: 18676552
references.citation: Arch Dis Child Fetal Neonatal Ed. 2005 Mar;90(2):F128-33
references.pmid: 15724036
references.citation: Early Hum Dev. 1987 Jan;15(1):45-52
references.pmid: 3816638
references.citation: Pathology. 2008 Jun;40(4):372-6
references.pmid: 18446627
references.citation: Early Hum Dev. 1999 Apr;54(3):245-58
references.pmid: 10321791
references.citation: Stat Med. 2003 Aug 30;22(16):2591-602
references.pmid: 12898546
references.citation: J Perinatol. 2004 Jul;24(7):435-40
references.pmid: 15116139
references.citation: Semin Perinatol. 2003 Aug;27(4):281-7
references.pmid: 14510318
references.citation: Arch Gynecol Obstet. 2003 Nov;269(1):40-4
references.pmid: 12682849
references.citation: Pediatrics. 2009 Apr;123(4):1124-31
references.pmid: 19336371
references.citation: J Perinat Med. 2005;33(5):428-34
references.pmid: 16238538
references.citation: Pediatrics. 1998 Apr;101(4 Pt 1):642-7
references.pmid: 9521949
references.citation: Am J Obstet Gynecol. 2008 Jul;199(1):52.e1-52.e10
references.pmid: 18313635
references.citation: Am J Obstet Gynecol. 2004 Aug;191(2):481-7
references.pmid: 15343225
references.citation: Pediatr Clin North Am. 1986 Feb;33(1):179-201
references.pmid: 3081865
references.citation: Arch Dis Child Fetal Neonatal Ed. 2007 May;92(3):F189-92
references.pmid: 16547077
references.citation: Pediatrics. 2002 Jul;110(1 Pt 1):143-51
references.pmid: 12093960
references.citation: Am J Obstet Gynecol. 2008 Jan;198(1):110.e1-7
references.pmid: 18166321
references.citation: Pediatrics. 1996 Feb;97(2):210-5
references.pmid: 8584379
references.citation: Am J Epidemiol. 2008 Nov 1;168(9):980-9
references.pmid: 18756014
references.citation: J Matern Fetal Neonatal Med. 2008 Jan;21(1):9-23
references.pmid: 18175241
references.citation: Pediatrics. 1997 Aug;100(2):E4
references.pmid: 9233975
references.citation: Pediatr Dev Pathol. 2004 May-Jun;7(3):237-49
references.pmid: 15022063
references.citation: J Perinat Med. 2004;32(2):162-7
references.pmid: 15085893
references.citation: Pediatrics. 2003 Mar;111(3):483-7
references.pmid: 12612225
references.citation: Semin Perinatol. 2008 Jun;32(3):201-5
references.pmid: 18482622
references.citation: J Pediatr. 2002 Feb;140(2):171-6
references.pmid: 11865267
references.citation: Pediatrics. 1999 Aug;104(2):e17
references.pmid: 10429135
references.citation: Am J Respir Crit Care Med. 2007 May 15;175(10):978-85
references.pmid: 17272782
references.citation: Eur Respir J. 2004 Nov;24(5):731-3
references.pmid: 15516664
references.citation: Am J Epidemiol. 2008 Jul 15;168(2):170-8
references.pmid: 18511427
references.citation: Acta Paediatr. 1996 Jul;85(7):843-8
references.pmid: 8819552
references.citation: J Matern Fetal Neonatal Med. 2008 May;21(5):279-87
references.pmid: 18446652
references.citation: Biol Neonate. 2005;88(2):129-35
references.pmid: 15908743
references.citation: Am J Obstet Gynecol. 1999 Oct;181(4):773-9
references.pmid: 10521727