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 Researchers focused on the most vulnerable subset of premature
babies: those born at no more than 28 weeks gestation. These babies
are too frail and weak to breathe on their own; they often lack a
lining in the lungs known as surfactant that keeps tiny air spaces
called alveoli from collapsing with each exhalation.
When researchers examined data on about 300 extremely small, low
birth weight babies, they found these early arrivals were much more
likely to have small airway obstruction at ages 8 and 18 than a
group of 260 otherwise similar babies who were born full-term and
normal size.
Furthermore, the preemies had a greater increase in small airway
obstruction between ages 8 and 18, compared with full-term babies.
“Since surfactant in healthy pregnancies is produced mostly after
34-35 weeks of pregnancy in the fetus, infants born before this time
are more likely than babies born after 34-35 weeks to have
surfactant deficiency, and hence breathing difficulty after birth,”
said lead study author Dr. Lex Doyle, a pediatrics researcher at the
Royal Women’s Hospital in Australia.
A typical pregnancy lasts about 40 weeks and babies that arrive
after 37 weeks are considered full term. In the weeks immediately
after birth, preemies often have difficulty breathing and digesting
food. Some premature infants also encounter longer term challenges
such as impaired vision, hearing, and cognitive skills as well as
social and behavioral problems.
For the current study, Doyle and colleagues focused on infants born
in 1991 to 1992, just as synthetic and natural surfactants made of
lipids and proteins became available in Australia to treat preterm
infants. Doctors can inject liquid containing these surfactants
directly into the air passages of the lung to improve breathing.
Within the preemie group, the subset of early arrivals who also had
lung damage caused by time on a respirator or long-term oxygen use
had worse lung function at age 8 and age 18 than the preterm babies
that didn’t have these issues.
In addition, preemies who became smokers by age 18 also had worse
lung function than preemies who never smoked, researchers report in
the journal Thorax.
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One limitation of the study is the lack of follow-up after age 18,
because lung development typically continues into the 20s, the
authors note.
Still, the findings suggest that as preemies become adults, they
need to make sure to alert doctors about their early arrival and be
monitored for potential breathing problems, Doyle said.
“Knowledge that they were born preterm and any complications they
had should be part of their medical history for life,” Doyle said.
“They would, of course, also be wise not to smoke.”
Parents and children should also pay close attention to any
shortness of breath, especially during exercise, said Dr. Marjaana
Tikanmaki, a researcher at the National Institute for Health and
Welfare and University of Oulu in Finland.
“It could be a sign of airway obstruction,” Tikanmaki, who wasn’t
involved in the study, said by email. “Reversible airway
obstruction, asthma, can be treated with regular inhaled
corticosteroids and with salbutamol that opens small airways in
acute shortage of breath.”
SOURCE: http://bit.ly/2csWAB4 Thorax, online September 6, 2016.
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