Racial

differences
in
pulmonary
function
among
preterm
infants
Mahima Venkatesh, MPH , Neera Goyal, MD , Matthew Fenchel, MS , Karen McDowell, MD , Suhas Kallapur, MD
1

University of Cincinnati College of Medicine, Cincinnati, Ohio; 2Department of Neonatology, Cincinnati Childrens Hospital, Cincinnati, Ohio; 3Department of
Biomedical Informatics, Cincinnati Childrens Hospital, Cincinnati, Ohio; 4Department of Pulmonology, Cincinnati Childrens Hospital, Cincinnati, Ohio
1

Preterm birth, (<37 weeks gestation)~10% U.S. births

80-90% are moderate and late preterm (32-36 weeks)
Known racial disparities in preterm birth and in childhood
wheezing disorders
Poorer infant pulmonary function testing (iPFT) is
associated with increased risk of childhood
asthma and respiratory morbidity
Unclear whether there are racial differences in lung
function during early life
Unclear whether comorbidities of preterm birth (e.g.
prenatal inflammation) and race independently modulate
infant lung function

Methods Infant Pulmonary Function test (iPFT)

Evaluate independent association between race and

iPFT results at 6-12 months of age among infants born
at 32-36 weeks gestation

Testing performed at 6-12 months of age

nSpire Infant Pulmonary Lab system under chloral
hydrate (rectal) sedation
Raised-volume rapid
thoracoabdominal
compression technique
and infant plethysmography

Multivariable linear and logistic regression analysis

tested the independent effect of race on iPFT results and
clinical respiratory outcomes
Model adjusted for:
-Gestational age
-Twin status
-Chorioamnionitis
-Postnatal exposures to passive smoking
-Intensive respiratory support (CPAP and Mechanical
ventilation)
-Insurance status as proxy for socioeconomic status.

150

Black

Mixed

100

Methods- Lung Physiological Variables

Forced vital capacity (FVC): the total volume that can be

forcefully expired from a maximum inspiratory effort (L)
Forced expiratory volume in 0.5 second (FEV0.5)
Ratio of FEV0.5 to FVC (FEV0.5/FVC)
Flow when 75% of FVC has been exhaled (FEF75)
All of the values were percent of predicted values for
each measurement.

PFTs
This figure shows lower FVC, FEV, and FEF75 in black infants, unadjusted
for confounders.

Table 2: Association of infant race with iPFTs after

adjustments using multivariable linear regression
FVC %
FEV %
FEV/FVC FEF75 %
Predicte Predicte %
Predicted
d
d
Predicted

Whit
e

Ref

Black -13.5
(-25.1,
-1.8)

Ref

Ref

Ref

-15.4
(-26.5,
-4.4)

-1.35
(-7.4, 4.3)

-19.0
(-41.2,
3.2)

Mixe -11.1
-7.3
4.0
0.3
Table 3: Clinical outcomes by Race (unadjusted)
d
(-26.7,
(-22.0,
(-4.1, 12.1 (-29.5,
4.4)
7.4)
White
Black
Mixed30)
P

200

White

Methods Patient Population

Methods - Statistics

50

Evaluate independent association between iPFT results

and clinical respiratory outcomes at 6-12 months of age
among infants born at 32-36 weeks gestation

Retrospective analysis of existing data from a

prospective cohort study of preterm infants born at 32-36
weeks at Good Samaritan Hospital, Cincinnati
Participants recruited to follow up at 6-12 months of age
for:
-infant pulmonary function testing (iPFT) (n=70)
-administration of a validated pulmonary
questionnaire by trained study personnel (n=186)

Results

Figure 1: Box Plot of Race and PFT distribution

250
(unadjusted)

http://www.carefusion.com/assets/images/international/ourproducts/respiratory-care/cardiopulmonary/masterscreenbabybody-plethysmograph_4.jpg

Objectives

Results

% Predicted

Background

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/pulmonary-function-testing/

Results
Table 1: Demographic and Clinical Characteristics by
Infant Race
White Black
Multi- P
(n=41 (n=22)
)

Racial
(n=7)

value

Female (%)

53.7%

31.8%

71.4%

0.11

Gestational Age
in weeks (mean)

34.75

34.91

35.71

0.19

Mechanical
Ventilation (%)

17.1%

22.7%

28.6%

0.73

Medicaid
Insurance

58.5%

22.7%

42.9%

0.01

Histologic
Chorioamnionitis

17.1%

54.6%

14.3%

0.005

Maternal
Smoking

41.5%

13.6%

28.6%

Wheeze
caregiver
reported (%)

(n=41)

(n=22)

(n=7)

value

26.8%

45.5%

42.9%

0.29

Physician
14.6%
40.9%
14.3% 0.05
diagnosis of
bronchitis,
bronchiolitis, or
pneumonia
(%)
Figure 2: Association
of low iPFTs (85% predicted or

lower) with clinical outcomes (Unadjusted)

FVC

0.08

*Multi-Racial defined as infants identifying with two or more racial

backgrounds.

Bronch

FEV
FEF75

Table 4: Association of iPFTs with clinical outcomes

using
multivariable
logistic regression
Wheeze
Physician
(odds ratio)
diagnosis of
bronchitis,
bronchiolitis,
or pneumonia
(odds ratio)
FVC % Predicted
Low (85% and
below)

0.62 (0.18,
2.1)

0.43
(0.07, 2.6)

FEV % Predicted
Low (85% and
below)

1.31 (0.37,
4.72)

1.50
(0.27, 8.28)

FEV/FVC %
Predicted
Low (85% and
below)

1.19 (0.07,
19.9)

>999.999
(<0.001,
>999.999)

Summary of Results

FEF75 %
1.36 (0.35,
3.65 (0.39,
Predicted
5.32)
35.67)
In a (85%
cohort
of late preterm infants (n=70)
Low
and
below)
Compared to white infants, Black infants had

higher rates of Histologic Chorioamnionitis

After adjusting for confounders, Black infants
had lower FEV and FVC but not FEV/FVC and
FEF75 compared to White Infants at 6-12
months
Significant increase in diagnosis of bronchitis,
bronchiolitis, or pneumonia in black infants in
the first year of life (unadjusted)
No statistically significant correlation between
PFT results and clinical outcomes

Conclusions

Our study suggests the possibility that racial

disparities in childhood respiratory outcomes
may relate to impaired pulmonary function in
the first year of life

Wheeze

Acknowledgements
Odds Ratio
*Bronch: Physician diagnosis of bronchitis, bronchiolitis, or
This figure
pneumonia
shows. increased wheeze and Physician diagnosis of
bronchitis, bronchiolitis, or pneumonia with low FVC, FEV, and FEF75
(85% predicted or lower), unadjusted for confounders.

Summer Medical Student Respiratory Research Fellowship

(SMURRF) Program- Dr. Hardie and Dr. Clancy