Expiratory airflow at 7–8 years of age in children born extremely low birthweight from 14 years before to 14 years after the introduction of exogenous surfactant

BACKGROUND: It is unclear if expiratory airflow in survivors born extremely low birth weight (ELBW; 500–999 g) has improved after the introduction of exogenous surfactant into clinical practice in 1991. The primary aim of this study was to describe the changes in airflow at 7–8 years of age of survivors born ELBW in five discrete cohorts from 14 years before to 14 years after the introduction of exogenous surfactant into clinical practice. METHODS: The cohorts comprised consecutive survivors born ELBW in 1977–82 and 1985–87 at the Royal Women's Hospital, Melbourne, and in 1991–92, 1997 and 2005 in the state of Victoria, Australia. Survival rates to 2-years of age for infants born ELBW in the state of Victoria rose from approximately 1-in-4 to 3-in-4 over the time of this study. Expiratory airflow measurements at 7–8 years included the forced expired volume in 1 s (FEV(1)), converted to z-scores for age, height, sex, and race. FINDINGS: There were 596 ELBW participants with expiratory flow data, 280 (47%) of whom had bronchopulmonary dysplasia (BPD). Overall, there was little change in zFEV(1) over the 28-year period (mean change per year; 0.003, 95% CI −0.010, 0.015, P = 0.67). There was, however, evidence of an interaction between BPD and year; zFEV(1) in those who had BPD fell over time (mean change per year −0.019, 95% CI −0.037, −0.009, P = 0.035), whereas zFEV(1) improved in those who did not have BPD (mean change per year 0.021, 95% CI 0.006, 0.037, P = 0.007). INTERPRETATION: Contrary to recent evidence, expiratory airflow of children born ELBW has not improved with the introduction of surfactant, and may be deteriorating in those who had BPD. FUNDING: 10.13039/501100000925National Health and Medical Research Council (Australia); Victorian Government’s Operational Infrastructure Support Program.