Cardiopulmonary exercise testing in adolescence following extremely premature birth

Background: Although extremely premature birth disrupts lung development, adolescent survivors of extreme prematurity show good clinical and physiologic outcomes. Cardiopulmonary limitations may not be clinically evident at rest. Data regarding exercise limitation in adolescents following preterm birth in the postsurfactant era are limited.Research Question: What are the long-term effects of bronchopulmonary dysplasia (BPD) and extreme prematurity (<29 weeks) on ventilatory response during exercise in adolescents in the postsurfactant era?Study Design and Methods: We followed a longitudinally recruited cohort of children aged 13-19 years who were born at a gestational age of <29 weeks (study group - SG). We compared the cardiopulmonary exercise testing (CPET) results of those with and without BPD, to their own CPET results from elementary school age (mean 9.09 +/- 1.05 years).Results: Thirty-seven children aged 15.73 +/- 1.31 years, mean gestational age 26 weeks ( +/- 1.19), completed the study. CPET parameters in adolescence were within the normal range for age, including mean VO2 peak of 91% predicted. The BPD and non-BPD subgroups had similar results. In the longitudinal analysis of the SG, improvement was observed in adolescence, compared with elementary school age, in breathing reserve (36.37 +/- 18.99 vs. 26.58 +/- 17.92, p = 0.044), tidal volume as a fraction of vital capacity achieved at maximal load (0.51 +/- 0.13 vs. 0.37 +/- 0.08, p < 0.001), and respiratory exchange ratio at maximal load (1.18 +/- 0.13 vs. 1.11 +/- 0.10, p = 0.021).Interpretation: In the current cohort, adolescents born extremely premature have essentially normal ventilatory response during exercise, unrelated to BPD diagnosis. CPET results in this population improve over time.