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The following is a summary of “Physiologic Pulmonary Phenotyping of Infants Born Preterm and Post-Discharge Respiratory Morbidity,” published in the January 2025 issue of Pediatrics by Tepper et al.
This study investigated whether measures of airway and parenchymal function could identify distinct subgroups of preterm infants based on their predominant pulmonary pathophysiology and whether these subgroups had differential risks for respiratory disease during infancy. A prospective cohort of 125 preterm infants was enrolled, with clinical follow-up initiated after neonatal intensive care unit (NICU) discharge. Monthly questionnaires documented wheezing and healthcare visits for respiratory illnesses, while lung function testing at 5 months corrected age included forced expiratory flows (FEF75), VA, and the carbon monoxide transfer constant (DL/VA). Two phenotypic classification approaches were used: one based on predefined thresholds for FEF75 and DL/VA z-scores and another employing k-means clustering for unbiased categorization.
Four distinct pulmonary physiologic phenotypes emerged, representing infants with predominantly impaired airway and/or parenchymal function. These phenotypes provided more precise predictions of respiratory morbidity during infancy compared to traditional clinical parameters such as gestational age (GA), sex, and a diagnosis of bronchopulmonary dysplasia (BPD). Notably, the worst physiologic phenotypes, characterized by marked airway and parenchymal impairment, were associated with lower GA at birth but demonstrated superior predictive value for respiratory outcomes. The area under the curve (AUC) for these phenotypes was 0.71 for respiratory illnesses and 0.69 for wheezing, outperforming the AUC of 0.63 derived from GA, sex, and BPD diagnosis.
These findings suggest that physiologic pulmonary phenotypes offer a more nuanced understanding of the heterogeneity in pulmonary outcomes among preterm infants. Infants classified into the most severe phenotypic groups were at higher risk for respiratory morbidities during infancy, emphasizing the potential utility of these phenotypes in stratifying risk and guiding clinical management. The study underscores the importance of individualized therapeutic strategies based on pulmonary function profiles, which may help mitigate long-term respiratory sequelae in this vulnerable population.
In conclusion, physiologic phenotyping using measures of airway and parenchymal function provides valuable insights into the pulmonary health of preterm infants and offers a framework for predicting and managing respiratory morbidity. Future research should explore the application of these phenotypes in larger cohorts to refine predictive models and develop targeted interventions.
Source: sciencedirect.com/science/article/abs/pii/S0022347625000150
