Respiratory and Cardiovascular Outcomes in Survivors of Extremely Preterm Birth at 19 Years.

Rationale Growth and development during adolescence may modify the respiratory and vascular differences seen among extremely preterm (EP) individuals in childhood and early adolescence. Objective To assess the trajectory of respiratory and cardiovascular outcomes at transition to adulthood in a national longitudinal cohort study of births before 26 weeks of gestation in the UK and Eire. Method 129 EP participants and 65 controls attended for a center-based evaluation at 19 years of age. Standardized measures of spirometry, haemodynamics, functional capacity and markers of inflammation were made in EP subjects with and without neonatal bronchopulmonary dysplasia (BPD) and term born controls, at 19 years of age and compared to previous assessments. Results Compared to controls, the EP group were significantly impaired on all spirometric parameters (Mean FEV1 z score: -1.08 SD (95%CI: -1.40 to -0.77)) and had lower FeNO concentrations (13.9 vs. 24.4 ppb, p<0.001) despite a higher proportion with bronchodilator reversibility (27% vs. 6%). The EP group had significantly impaired exercise capacity. All respiratory parameters were worse following neonatal BPD and respiratory function differences were similar at 11 and 19 years. Augmentation index (AIx) was 6% higher in the EP group and associated with increased total peripheral resistance (difference in means 96.4 (95%CI: 26.6, 166.2) dyne/s/cm-5) and elevation in central but not peripheral blood pressure. Central systolic and diastolic blood pressure increased more quickly over adolescence in the EP group compared to controls. Conclusions Clinicians should address both cardiovascular and respiratory risk in adult survivors of extremely preterm birth.