Christopher Harris, Allan Jenkinson, Sanja Zivanovic, Kuberan Pushparajah, Theodore Dassios, Steven H. Abman, Anne Greenough
King’s College London, King’s College Hospital NHS Foundation Trust and Imperial College Healthcare NHS Trust. University of Colorado School of Medicine.
united Kingdom and United States
Pediatric Research
Pediatr Res 2026;
DOI: 10.1038/s41390-026-05260-5
Abstract
Background: Premature birth is associated with altered pulmonary vascular development and raised pulmonary artery pressures (PAPs). Arrested alveolar and vascular development reduce lung surface area, which can be assessed by the diffusion capacity of the lung for carbon monoxide (DLCO) and the carbon monoxide transfer coefficient (KCO). We hypothesise that abnormal DLCO and KCO would be associated with higher PAPs in school-aged children.
Methods: We enroled participants born premature ( < 29 weeks gestation) from the United Kingdom Oscillation Study and age-matched term-born children. Echocardiography was performed, including estimates of systolic and mean PAP (SPAP and MPAP) and spirometry and DLCO measurements were made. An abnormal result was Z score <-1.64 and severely abnormal Z score <-1.96.
Results: One hundred ninety-two participants were assessed at 12 (range 10-14) years; 60% born prematurely. Fifty-eight children had severely abnormal KCO (95% preterm) which was associated with a higher SPAP (p < 0.001) and MPAP (p < 0.001)) and a lower forced expiratory volume in one second to forced vital capacity ratio (FEV1/FVC) (p < 0.001).
Conclusion: Low KCO was associated with higher SPAP and MPAP and lower FEV1/FVC in school-aged children born premature. We speculate early and serial assessments of lung function with KCO may identify subjects born preterm at high risk for pulmonary hypertension who would benefit from cardiac assessment.
Impact: Premature birth is associated with altered pulmonary vascular development and raised pulmonary artery pressures (PAPs), contributing to increased risk for late cardiopulmonary disease. Abnormal KCO was associated with higher PAPs in school-aged children born premature. Assessment of KCO might identify individuals born prematurely who are at greater risk for late cardiopulmonary disease as adults and potentially benefit from cardiac assessment and intervention to prevent progression to higher PAPs and more severe right ventricular dysfunction in early adulthood.
Category
Class III. Pulmonary Hypertension Associated with Lung Disease
Diagnostic Testing for Pulmonary Vascular Disease. Non-invasive Testing
Potential Biomarkers Associated with Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes