title: Encouraging pulmonary outcome for surviving, neurologically intact, extremely premature infants in the postsurfactant era.
abstract: OBJECTIVE
  The aim of this study was to determine the long-term pulmonary outcome of extreme prematurity at a single tertiary-care center from 1997 to 2001 in the postsurfactant era.
  
  
  METHODS
  We assessed symptoms, exhaled nitric oxide, spirometry, methacholine challenge (provocative concentration of methacholine required to decrease FEV₁ by 20% [PC(20)]), lung volumes, diffusion, and cardiopulmonary exercise tolerance.
  
  
  RESULTS
  Of 279 infants born, 192 survived to discharge, and 79 of these developed bronchopulmonary dysplasia (BPD) (65 mild, 12 moderate, two severe). We studied a subgroup of 53 neurologically intact preterm subjects aged 10 ± 1.5 years (28 with BPD [born, 26.2 ± 1.4 weeks; birth weight, 821 ± 164 g] and 25 without BPD [born, 27.2 ± 1 weeks; birth weight, 1,050 ± 181 g]) and compared them with 23 term control subjects. Of the BPD cases, 21 were mild, seven were moderate, and none was severe; 77.4% of subjects received antenatal steroids, and 83% received postnatal surfactant. Sixty percent of the preterm subjects wheezed at age < 2 years compared with 13% of the control subjects (P < .001), but only 13% wheezed in the past year compared with 0% of control subjects (not significant). For preterm and control subjects, respectively (mean ± SD), FEV₁ % predicted was 85% ± 10% and 94% ± 10% (P < .001), with limited reversibility; residual volume/total lung capacity was 29.3% ± 5.5% and 25% ± 8% (P < .05); diffusing capacity/alveolar volume was 89.6% ± 9.2% and 97% ± 10% (P < .005); and PC(20) was 6.5 ± 5.8 mg/mL and 11.7 ± 5.5 mg/mL (P < .001). PC(20) was < 4 mg/mL in 49% of preterm subjects despite normal exhaled nitric oxide. Most measurements were similar in premature subjects with and without BPD. Peak oxygen consumption and breathing reserve were normal, but % predicted maximal load (measured in Watts) was 69% ± 15% for subjects with BPD compared with 88% ± 23% for subjects without and 86% ± 20% for control subjects (P < .01).
  
  
  CONCLUSIONS
  Pulmonary outcome was encouraging at mid-childhood for neurologically intact survivors in the postsurfactant era. Despite mechanical ventilation and oxygen therapy, most had no or mild BPD. Changes found probably reflect the hypoplastic lungs of prematurity.
authors.affiliation: Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva.
authors.forename: Eytan
authors.initials: E
authors.lastname: Kaplan
authors.affiliation: Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva.
authors.forename: Ephraim
authors.initials: E
authors.lastname: Bar-Yishay
authors.affiliation: Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Dario
authors.initials: D
authors.lastname: Prais
authors.affiliation: Department of Neonatal Intensive Care, Schneider Children's Medical Center of Israel, Petah Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Gil
authors.initials: G
authors.lastname: Klinger
authors.affiliation: Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Meir
authors.initials: M
authors.lastname: Mei-Zahav
authors.affiliation: Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Huda
authors.initials: H
authors.lastname: Mussaffi
authors.affiliation: Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva.
authors.forename: Guy
authors.initials: G
authors.lastname: Steuer
authors.affiliation: Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva.
authors.forename: Shai
authors.initials: S
authors.lastname: Hananya
authors.affiliation: Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva.
authors.forename: Yelena
authors.initials: Y
authors.lastname: Matyashuk
authors.affiliation: Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva.
authors.forename: Nassrin
authors.initials: N
authors.lastname: Gabarra
authors.affiliation: Department of Neonatal Intensive Care, Schneider Children's Medical Center of Israel, Petah Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Lea
authors.initials: L
authors.lastname: Sirota
authors.affiliation: Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: hblau@post.tau.ac.il.
authors.forename: Hannah
authors.initials: H
authors.lastname: Blau
mesh_terms: D001921:Brain / Q000502:physiology*; D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D062071:Infant, Extremely Premature / Q000502:physiology*; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008168:Lung / Q000187:drug effects / Q000502:physiology / Q000601:surgery*; D008297:Male; D011379:Prognosis; D011663:Pulmonary Surfactants / Q000494:pharmacology / Q000627:therapeutic use*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D013534:Survival / Q000502:physiology*; D062606:Tertiary Care Centers
chemical_list: D011663:Pulmonary Surfactants