Effect of Preterm Birth on Exercise Capacity: A Systematic Review and Meta-Analysis

Background: Survivors of preterm-birth have increased prevalence of respiratory, cardiovascular, and neurological diseases in later life however, the overall impact of prematurity on cardiorespiratory exercise capacity is unclear. Objective: We, therefore, systematically reviewed the literature on cardiorespiratory exercise capacity in survivors of preterm birth. Methodology: Relevant studies up to March 2013 were searched using eight electronic health databases. Studies reporting exercise capacity in participants born preterm (<37 weeks) were included. The main outcome of interest was oxygen uptake ((V) over dotO(2)max) at maximal exercise. Data were categorized into four groups: (i) preterm-born subjects including those with or without bronchopulmonary dysplasia (BPD) but excluding study groups biased towards BPD; (ii) preterm-born subjects (BPD excluded); (iii) preterm-born subjects who had BPD28 (defined as oxygen dependency at 28 days of life) in infancy; (iv) preterm born subjects with BPD36 (oxygen dependency at 36 weeks post menstrual age) in infancy. Results: From 9,341 abstracts, 22 included publications reported (V) over dotO(2)max in ml/kg/min from 685 preterm and 680 term-born subjects. Overall 20 studies reported results for preterm-born subjects including BPD; 14 studies for the preterm group excluding BPD; 10 studies for the BPD28 group; and 8 studies for BPD36 group. The mean differences (95% CI) for the four groups were -2.20 (-3.70, -0.70) ml/kg/min; -2.26 (-4.44, -0.07ml/kg/min; -3.04 (-5.48, -0.61) ml/kg/min, and -3.05 (-5.93, -0.18) ml/kg/min, respectively. Conclusion: Despite marked deficits in spirometry, preterm-born children have a marginally decreased (V) over dotO(2)max, which is unlikely to be of great clinical significance. Pediatr Pulmonol. 2015; 50:293-301. (c) 2014 Wiley Periodicals, Inc.