Preemies Aren't Little Term Babies

Disorders of feeding and swallowing, and the risk of aspiration are increased in premie infants.  This study highlights that a routine surgery performed for a common pediatric disorder known as as laryngomalacia (floppy airway) may significantly raise risk for aspiration more so than in term infants. Dr. Susarla

The effects of prematurity on incidence of aspiration following supraglottoplasty for laryngomalacia.

Abstract

OBJECTIVES:

To determine if patients who were born premature have a higher incidence of aspiration following supraglottoplasty compared to patients born full term.

STUDY DESIGN:

Retrospective study.

METHODS:

Two thousand three hundred sixty (2360) patient charts from Riley Hospital for Children were reviewed retrospectively. Patients had already been treated for laryngomalacia with supraglottoplasty by Dr. Bruce Matt. Estimated weeks gestational age at birth was recorded for each patient. Prematurity was stratified as mild (32-36 weeks gestational age [WGA]), very (28-31 WGA), or extremely (<28 WGA). Patients were excluded from the study if they had suspected aspiration with chronic cough, pneumonia, chronic lung disease, or documented aspiration prior to supraglottoplasty.

RESULTS:

As previously shown, 75 patients (3.2%) had aspiration following supraglottoplasty. Twenty of these patients were preterm infants at birth. The rate for aspiration following supraglottoplasty for former premature infants was statistically significant (5.9%, odds ratio = 2.3, P = .0032).

CONCLUSIONS:

Children who were born premature have a higher rate of postoperative aspiration following supraglottoplasty; however, supraglottoplasty should still be considered as treatment for laryngomalacia as the rate is still relatively low (5.9%).

Abstract linked here.

Preterm Birth May Raise Child's Asthma Risk, Study Suggests

Premie infants seem to have a higher risk for early childhood wheezing, which often follows a pattern consistent with asthma. Dr. Susarla

THURSDAY, March 13, 2014 (HealthDay News) -- A new study may add asthma to the list of downsides of being born too early.

Children who were born prematurely appear to be at higher risk for asthma and wheezing disorders, according to a new review.

Researchers led by Dr. Aziz Sheikh, of Brigham and Women's Hospital in Boston, looked at 30 studies focused on links between preterm birth -- defined as less than 37 weeks' gestation -- and asthma or wheezing disorders among more than 1.5 million children.

Their analysis found that preterm babies were 70 percent more likely than full-term infants to develop asthma or wheezing disorders later in childhood. Overall, close to 14 percent of "preemie" babies went on to develop asthma during childhood, compared to 8.3 percent of babies born at term.

The risk was even higher for very preterm babies, defined as children born at less than 32 weeks' gestation. These infants were about three times more likely than full-term babies to develop asthma or wheezing disorders later on.

"Worldwide, more than 11 percent of babies are born preterm," Sheikh said in a hospital news release.

"As asthma is a chronic condition, our findings underscore the need to improve our understanding of the mechanisms underlying the association between preterm birth and asthma or wheezing disorders in order to develop preventive and therapeutic interventions," he said.

Although the study found an association between premature birth and later asthma, it could not prove cause and effect. The findings were published in a recent issue of the journal PLoS Medicine.

Read article here.

Lung function changes seen in later childhood in premature infants

Children with history of bronchopulmonary dysplasia, also commonly referred to as chronic lung disease have increased risk for respiratory symptoms in later childhood.  This seems to correlate with lung function changes that can be measured with simple non-invasive office testing. Dr. Susarla

Pulmonary Outcome in Former Preterm, Very Low Birth Weight Children with Bronchopulmonary Dysplasia: A Case-Control Follow-Up at School Age.

Maike Hove, Freerk Prenzel, Holm H Uhlig, Eva Tillig

OBJECTIVE:

To assess and compare long-term pulmonary outcomes in former preterm-born, very low birth weight (VLBW) children with and without bronchopulmonary dysplasia (BPD) born in the surfactant era.

STUDY DESIGN:

Pulmonary function tests (ie, spirometry, body plethysmography, and gas transfer testing) were performed in children with a history of VLBW and BPD (n = 28) and compared with a matched preterm-born VLBW control group (n = 28). Medical history was evaluated by questionnaire.

RESULTS:

At time of follow-up (mean age, 9.5 years), respiratory symptoms (36% vs 8%) and receipt of asthma medication (21% vs 0%) were significantly more frequent in the preterm-born children with previous BPD than in those with no history of BPD. The children with a history of BPD had significantly lower values for forced expiratory volume in 1 second (z-score -1.27 vs -0.4; P = .008), forced vital capacity (z-score -1.39 vs -0.71 z-score; P = .022), and forced expiratory flow rate at 50% of forced vital capacity (z-score -2.21 vs -1.04; P = .048) compared with the preterm control group.

CONCLUSION:

Preterm-born children with a history of BPD are significantly more likely to have lung function abnormalities, such as airway obstruction and respiratory symptoms, at school age compared with preterm-born children without BPD.

Read article here.