Effect of preterm birth on later FEV1: a systematic review and meta-analysis

Abstract

Background Increasing evidence suggests that preterm birth affects later lung function. We systematically reviewed the literature to determine whether percentage predicted forced expiratory volume in 1 s (%FEV₁) is lower in later life in preterm-born subjects, with or without bronchopulmonary dysplasia (BPD), compared with term-born controls. Methods Studies reporting %FEV₁, with or without a term-born control group, in later life for preterm-born subjects (Results From 8839 titles, 1124 full articles were screened and 59 were included: 28 studied preterm-born children without BPD, 24 with BPD₂₈ (supplemental oxygen dependency at 28 days), 15 with BPD₃₆ (supplemental oxygen dependency 36 weeks postmenstrual age) and 34 born preterm. For the preterm-born group without BPD and for the BPD₂₈ and BPD₃₆ groups the mean differences (and 95% CIs) for %FEV₁ compared with term-born controls were −7.2% (−8.7% to −5.6%), −16.2% (−19.9% to −12.4%) and −18.9% (−21.1% to −16.7%), respectively. Pooling all data on preterm-born subjects whether or not there was a control group gave a pooled %FEV₁ estimate of 91.0% (88.8% to 93.1%) for the preterm-born cohort without BPD, 83.7% (80.2% to 87.2%) for BPD₂₈ and 79.1% (76.9% to 81.3%) for BPD₃₆. Interestingly, %FEV₁ for BPD₂₈ has improved over the years. Conclusions %FEV₁ is decreased in preterm-born survivors, even those who do not develop BPD. %FEV₁ of survivors of BPD₂₈ has improved over recent years. Long-term respiratory follow-up of preterm-born survivors is required as they may be at risk of developing chronic obstructive pulmonary disease.