OBJECTIVES:To investigate the effect of preterm birth on physical activity (PA) in 9- to 12-year-old children, and to describe group differences in relationships between PA and lung function, and PA and respiratory morbidity, between children born preterm and term. STUDY DESIGN:A total of 343 children completed follow-up including children born very preterm (VPT; <30 weeks of gestation, n = 91), moderate-to-late preterm (MLPT; 32-36 weeks of gestation, n = 139), and term (n = 113). PA was measured using 7-day accelerometry and the Physical Activity Questionnaire for Older Children (PAQ-C). Imputation models were used to handle missing data as the total sample recruited at birth included 551 participants. RESULTS:Children born VPT had more stationary (mean difference (MD): 32 minutes, 95% CI 4, 60; P = .024) and screen time (MD: 25 minutes, 95% CI 0.2, 50; P = .048), and had lower PAQ-C scores (MD: -0.3, 95% CI -0.4, -0.1; P = .001) than term-born children. Children born MLPT completed more screen time (MD: 22 minutes, 95% CI 1, 43; P = .038) than term-born children. All children failed to meet moderate-vigorous PA recommendations (≥60 minutes/day), with 16.6 minutes on average observed across all participants. CONCLUSIONS:Children born VPT were more sedentary with lower PAQ-C scores, and both preterm groups (VPT and MLPT) had higher screen time than children born at term. No children met moderate-vigorous PA guidelines, indicating early, targeted strategies to curb sedentary behavior and promote activity should be prioritized.

Abstract Multiple breath washout (MBW) is a non-invasive tidal breathing test that quantifies ventilation inhomogeneity by measuring how efficiently the lungs are able to clear an inert tracer gas such as nitrogen (N 2 ) or sulphur hexafluoride (SF 6 ), and holds the key advantage of being applicable to all age groups. Though first described over 60 years ago, MBW has only garnered increased interest in the past 20 years. This has primarily been driven by the development and availability of commercial equipment, which has seen momentous advances in rapid gas analysers, highly sensitive flow systems, and user-friendly software enhancements. The principal MBW outcome, Lung Clearance Index (LCI), reflects global gas mixing efficiency and is regarded as a more sensitive method to identify the subtle changes seen in early lung disease when compared to traditional lung function measures such as spirometry. These properties have seen MBW begin to transition from paediatric respiratory research in specialised laboratories towards becoming a routine clinical assessment. Although nitrogen-based systems are currently more common, the tracer gas selected can introduce important methodological differences, and SF 6 -based MBW remains the preferred method in infants. This review examines the physiological principles underpinning MBW, outlines key methodological aspects of testing, and discusses the interpretation and application of LCI in paediatric clinical practice.

Rationale: The effect of moderate to late preterm (MLP) birth (32-36 completed weeks' gestation) on childhood respiratory health is unclear. Objectives: To assess the effect of being born MLP, compared with being born at term (≥37 completed weeks' gestation), on lung function and respiratory morbidity at 9-10 years of age. Methods: A prospective cohort study was conducted among children born MLP or at term at the Royal Women's Hospital (Victoria, Australia). Participants completed pre and postbronchodilator spirometry, measurement of diffusing capacity of the lung for carbon monoxide, plethysmography, and multiple-breath washout at 9-10 years of age. Parents completed the ISAAC (International Study of Asthma and Allergies in Childhood) questionnaire. Mean differences in z-scores of lung function outcomes and risk ratio for ISAAC outcomes between those born MLP and those born at term were estimated using regression models with adjustment for potential confounding. Multiple imputation was used to handle missing data. Results: A total of 148 of 201 children born MLP and 120 of 201 term-born control subjects were assessed at 9-10 years. Compared with control subjects, children born MLP had lower mean z-scores for forced expiratory volume in 1 second (mean difference, -0.35 [95% confidence interval (CI), -0.61 to -0.08]), ratio of forced expiratory volume in 1 second to forced vital capacity (mean difference, -0.29 [95% CI, -0.58 to -0.01]), forced expiratory flow at 25-75% of forced vital capacity (-0.33 [95% CI, -0.62 to -0.04]), and diffusing capacity of the lung for carbon monoxide (-0.24 [95% CI, -0.45 to -0.03]). Participants born MLP had higher risk of experiencing asthma symptoms (risk ratio, 1.52 [95% CI, 1.08-2.14]). Conclusions: Children born MLP have lower lung function and increased risk of exhibiting asthma symptoms compared with term-born peers at 9-10 years. Such findings at the end of the first decade of life may portend adverse consequences for respiratory health in adulthood.

Introduction: While the short-term and acute physiological benefits of antenatal corticosteroids (ANCS) are well established for reducing the risk of respiratory distress syndrome in those born preterm, robust evidence regarding their long-term effects on lung health is lacking. Currently, World Health Organization guidelines advise restricting ANCS use to those of a gestational age less than 34 weeks to safeguard against unsafe use until further findings from long-term follow-up studies come to light. Aim: This study aimed to assess the effect of receiving one or more courses of ANCS on lung function at 9 years of age in children born moderate-to-late preterm (32 to 36 weeks’ gestation). Methods: Prospective cohort of children born moderate-to-late preterm at the Royal Women's Hospital Melbourne, Victoria, Australia. Participants completed spirometry, diffusing capacity of the lungs for carbon monoxide (DLCO), whole-body plethysmography and nitrogen multiple breath washout at 9 years of age. ANCS exposure was ascertained at birth via medical chart. Mean differences in z-score of lung function outcomes between those who received ANCS and those who did not receive ANCS were estimated using linear regression models with adjustment for potential confounding. Models were fitted using generalized estimating equations with an exchangeable correlation structure to account for clustering due to multiple births within the same family. Multiple imputation was used to handle missing data. Results: 120 (60%) participants received ANCS compared with 80 (40%) participants who did not (Table 1). The mean age at lung function follow-up was 9.8 years for both groups. In the ANCS group, 57 (47%) were born moderate preterm (32 to 33 weeks’ gestation) and 63 (53%) were born late preterm (34 to 36 weeks’ gestation). Among those who did not receive ANCS, 20 (25%) were born moderate preterm and 60 (75%) were born late preterm. Table 1. Differences in lung function z-score between participants who received ANCS and those who did not receive ANCS. Conclusion: Children born moderate-to-late preterm who received ANCS had worse expiratory airflow and gas trapping but similar gas transfer, overall lung volume and ventilation inhomogeneity compared with preterm peers who did not. Given that ANCS often provides only a modest reduction in respiratory morbidity for more ‘mature’ preterm infants, clinicians should carefully weigh the risks and benefits of ANCS use in this gestational group.

Bronchiolitis obliterans syndrome (BOS) is a severe complication following hemopoietic stem cell transplantation (HSCT) and is often undetected until there is significant deterioration in pulmonary function. Lung clearance index (LCI2.5) derived from the nitrogen multiple breath washout (N2MBW) test may be more feasible and sensitive than spirometry, which is currently used for surveillance and detection of BOS. We aimed to examine the feasibility of performing surveillance N2MBW in children post-HSCT, and in an exploratory analysis, determine if LCI2.5 led to earlier detection of BOS when compared to spirometric indices. Participants aged 5 to 17 years were recruited prior to receiving HSCT into a prospective, single-center, feasibility study at the Royal Children's Hospital, Melbourne. N2MBW and spirometry were performed within the month prior to transplant and repeated at 3, 6, 9, and 12 months post-transplant. Data were also collected on the presence of graft-versus-host (GVHD) disease in any organ, including the lungs. Twenty-one (12 male) children with a mean age of 13.4 (range 9.2 to 17.1) years at recruitment participated in this study. Prior to HSCT, all participants had normal LCI2.5, while 16 (76%) demonstrated normal forced expiratory volume in 1 second (FEV1). Ninety-nine percent of N2MBW tests were technically acceptable, compared with 66% of spirometry tests. Three participants developed BOS, while 2 participants died of other respiratory complications. At 6 and 12 months post-transplant, the BOS group had increases in LCI2.5 ranging from 3 to 5 units and mean reductions in FEV1 % predicted of 40% to 53% relative to pre HSCT values, respectively. In those who developed BOS, post-HSCT LCI2.5 values were significantly worse when compared with the no BOS group (P < .001). Relative changes in LCI2.5 and FEV1 were both predictive of BOS at 6 months post HSCT. This study demonstrates that N2MBW is a more feasible test compared with spirometry in children post HSCT. However, in an exploratory analysis, LCI2.5 did not lead to earlier detection of BOS, when compared to spirometry.

Numerous studies have investigated the physical health and development of children and adolescents conceived with assisted reproductive technology (ART). Less is known about the quality of life of ART-conceived adults. This study explores the contributions of being conceived with ART and psychosocial cofactors present in young adulthood to the quality of life of adults aged 22-35 years. Young adults conceived through ART or natural conception (NC) completed questionnaires which included a standardized measure of quality of life (World Health Organization Quality of Life - Brief assessment (WHOQoL-BREF)) when aged 18-28 years (T1) and again when aged 22-35 years (T2). The WHOQoL-BREF has four domains: (i) Physical, (ii) Psychological, (iii) Social relationships and (iv) Environment. A total of 193 ART-conceived and 86 NC individuals completed both questionnaires. When accounting for other cofactors in multivariable analyses, being ART-conceived was strongly associated with higher scores (better quality of life) on the Social relationships, and Environment WHOQoL-BREF domains at T2. In addition, less psychological distress, a better relationship with parents, a better financial situation, and perceptions of being about the right weight at T1 were associated with higher scores on one or more of the WHOQoL-BREF domains at T2. In conclusion, being ART-conceived can confer advantages in quality of life in adulthood, independent of psychosocial cofactors.

Introduction: The detrimental effect of birth at <32 weeks' gestation on lung function is well established. However, the effect of moderate-late preterm (32 to <37 weeks' gestation; MLP) birth on lung function during childhood remains unclear. Aim: To assess the effect of being born MLP, compared with being born at term, on lung function at 9 years of age. Methods: Prospective cohorts of children born either a) MLP or b) at term in the Royal Women's Hospital, Victoria, Australia. Participants completed spirometry, diffusing capacity for carbon monoxide (DLCO), body plethysmography and nitrogen multiple breath washout (N2MBW) at 9 years of age. Mean differences in z-scores of lung function outcomes between those born MLP and at term were estimated using linear regression models with adjustment for potential confounding. Results: 149 children born MLP and 77 term controls with a mean (SD) age of 9.9 (0.4) and 9.7 (0.3) years, respectively, underwent lung function testing (Table 1). Table 1. Mean differences in lung function z-scores between children born MLP and term. MD: mean difference; CI: confidence interval Conclusion: This study provides evidence that children born MLP have worse expiratory volumes compared with term-born controls. These differences are likely explained by smaller overall lung volumes, reflected by lower TLC, as opposed to a pattern of airflow obstruction.

Background Moderate-late preterm (MLP; 32 to <37 weeks' gestation) birth is associated with reduced expiratory airflow during child, adolescent and adult years. However, some studies have reported only minimal airflow limitation and hence it is unclear if clinical assessment in later life is warranted. Our aim was to compare maximal expiratory airflow in children and adults born MLP with term-born controls, and with expected norms. Methods We systematically reviewed studies reporting z-scores for spirometric indices (forced expired volume in 1 second [FEV1], forced vital capacity [FVC], FEV1/FVC ratio and forced expiratory flow at 25-75% of FVC [FEF25-75%]) from participants born MLP aged five years or older, with or without a term-born control group from 4 databases (MEDLINE, CINAHL, Embase, Emcare). Publications were searched for between the 22nd of September 2021 to the 29th of September 2021. A meta-analysis of eligible studies was conducted using a random effects model. The study protocol was published in PROSPERO (CRD #42021281518). Findings We screened 4970 articles and identified 18 relevant studies, 15 of which were eligible for meta-analysis (8 with term-born controls and 7 without). Compared with controls, MLP participants had lower z-scores ( mean difference [95% confidence interval] I-2) for FEV1 : -0.22 [-0.35, -0.09] 49.3%, FVC: -0.23 [-0.4, -0.06] 71.8%, FEV1/FVC: -0.11 [-0.20 to -0.03] 9.3% and FEF25-75%: -0.27 [-0.41 to -0.12] 21.9%. Participants born MLP also had lower z-scores, on average, when compared with a z-score of 0 (mean [95% CI] I-2) for FEV1 : -0.26 [-0.40 to -0.11] 85.2%, FVC: -0.18 [-0.34 to -0.02] 88.3%, FEV1/FVC: -0.24 [-0.43 to -0.05] 90.5% and FEF25-75%: -0.33 [-0.54 to -0.20] 94.7%. Interpretation Those born MLP had worse expiratory airflows than those born at term, and compared with norms, although reductions were modest. Clinicians should be aware that children and adults born MLP may be at higher risk of obstructive lung disease compared with term-born peers. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.

Exertional dyspnoea among children and adolescents is a common presenting complaint to general practitioners. Exertional dyspnoea is most commonly attributed to exercise-induced bronchoconstriction (EIB), but there are several other causes including hyperventilation syndrome, breathlessness associated with normal exercise limitation and exercise-induced laryngeal obstruction (EILO). The symptoms of EILO include stridor, throat tightness and difficulty on inspiration. If these are mistaken for EIB, children will receive asthma therapy. The underlying mechanism of EILO includes closure of the larynx during high-intensity exercise, which causes a reduction in airflow and breathlessness. This phenomenon is often associated with a background of psychological stress. Historically, a diagnosis of EILO has been considered 'rare' though this may be a reflection of under-recognition. Direct visual observation via laryngoscopy is the gold standard for diagnosis of EILO; however, this is rarely available even in specialised centres. Nevertheless, the diagnosis can usually be made by recognising the characteristic clinical pattern. Here we provide recommendations for appropriate investigations for the determination of EILO, together with suggested treatment.

With the emergence of cystic fibrosis transmembrane conductance regulator (CFTR) modulators, forced expiratory volume in 1 s (FEV1) may become a less sensitive measure of pulmonary disease progression in children with cystic fibrosis (CF). Increasing evidence shows that peak oxygen uptake (VO2peak) is a strong predictor of prognosis in CF. The primary aim of this study was to describe the associations between peak oxygen uptake, lung function, and bronchiectasis in children with CF in the era of CFTR modulators.

STUDY QUESTION:Is ART related with the association of American Heart Association (AHA) ideal cardiovascular health score and markers of subclinical atherosclerosis? SUMMARY ANSWER:The associations between AHA score and markers of subclinical atherosclerosis in ART and non-ART groups were similar in magnitude. WHAT IS KNOWN ALREADY:Long-term consequences of ART on cardiovascular health are unknown. STUDY DESIGN, SIZE, DURATION:The study cohort for the cross-sectional analyses consisted of 172 ART-conceived and 78 non-ART conceived individuals of same age (range 22-35 years). PARTICIPANTS/MATERIALS, SETTING, METHODS:Cardiovascular risk factor status was evaluated with American Heart Association (AHA) ideal cardiovascular health score consisting of seven factors (body mass index, blood pressure, total cholesterol, glucose, diet and physical activity, non-smoking). Carotid artery intima-media thickness (cIMT), arterial pulse-wave velocity (PWV) and retinal microvascular parameters were evaluated as markers of early atherosclerosis. Group comparisons in continuous variables were performed with t-tests. For categorical variables, comparisons were performed with chi-square tests. The relationships between AHA score and the markers of atherosclerosis were examined with linear regression analyses adjusted for age and sex. MAIN RESULTS AND THE ROLE OF CHANCE:There was no difference in AHA ideal health score between the ART and non-ART groups; mean (SD) scores were 4.1(1.4) versus 4.0(1.5), respectively, P = 0.65. No differences were observed between groups for any individual ideal health metric (P always >0.2). AHA score was not associated with cIMT or retinal measures in either group (P always >0.05). An inverse association was observed between AHA score and PWV in the ART group (beta (95% CI) -0.18(-0.26 to -0.10)). A numerically similar relationship was observed in the smaller non-ART group (-0.19(-0.39 to 0.01)). LIMITATIONS, REASONS FOR CAUTION:Even though this cohort is among the largest ART studies with extensive cardiovascular data, the sample is still relatively small and the statistical power is limited. As the study population was still in early adulthood, we were not able to evaluate the associations with clinical cardiovascular events, but utilized non-invasive methods to assess early markers of subclinical atherosclerosis. WIDER IMPLICATIONS OF THE FINDINGS:These findings suggest that ART-conceived individuals do not have increased vulnerability for cardiovascular risk factors. STUDY FUNDING/COMPETING INTEREST(S):This study was funded by a National Health & Medical Research Council Project Grant (APP1099641), The Royal Children's Hospital Research Foundation, Monash IVF Research and Education Foundation, and Reproductive Biology Unit Sperm Fund, Melbourne IVF. The authors have no conflicts of interest relevant to this article to disclose.

The recently published Global Lung Function Initiative (GLI) carbon monoxide transfer factor (TLCO) reference equations provide an opportunity to adopt a current, all-age, widely applicable reference set. The aim of this study was to document the effect of changing to GLI from commonly utilised reference equations on the interpretation ofTLCOresults.33 863TLCOresults (48% female, 88% Caucasian, n=930 aged <18 years) from clinical pulmonary function laboratories within three Australian teaching hospitals were analysed. The lower limit of normal (LLN) and proportion of patients with aTLCObelow this value were calculated using GLI and other commonly used reference equations.The averageTLCOLLN for GLI was similar or lower than the other equations, with the largest difference seen for Crapoequations (median: −1.25, IQR: −1.64, −0.86 mmol·min−1·kPa−1). These differences resulted in altered rates of reducedTLCOfor GLI particularly for adults (+1.9%versusMillerto −27.6%versusCrapo), more so than for children (−0.8%versusKimto −14.2%versusCotes). For adults, the highest raw agreement for GLI was with Millerequations (94.7%), while for children it was with Kimequations (98.1%). Results were reclassified from abnormal to normal more frequently for younger adults, and for adult females, particularly when moving from Rocato GLI equations (30% of femalesversus16% of males).The adoption of GLITLCOreference equations in adults will result in altered interpretation depending on the equations previously used and to a greater extent in adult females. The effect on interpretation in children is less significant.

Pediatric PulmonologyVolume 55, Issue 11 p. 2840-2841 LETTER TO THE EDITOR Identification of pediatric bronchiolitis obliterans syndrome posthematopoietic stem cell transplantation; surveillance is the key Shivanthan Shanthikumar FRACP, Corresponding Author Shivanthan Shanthikumar FRACP shivanthan.shanthikumar@rch.org.au orcid.org/0000-0001-6000-3180 Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, Australia Correspondence Shivanthan Shanthikumar, FRACP, Respiratory Medicine, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia. Email: shivanthan.shanthikumar@rch.org.auSearch for more papers by this authorLiam Welsh PhD, Liam Welsh PhD Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, AustraliaSearch for more papers by this authorNicole Westrupp MS, Nicole Westrupp MS Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, AustraliaSearch for more papers by this authorTheresa Cole PhD, Theresa Cole PhD Department of Paediatrics, University of Melbourne, Melbourne, Australia Allergy and Immunology, Royal Children's Hospital, Melbourne, AustraliaSearch for more papers by this authorKatherine B. Frayman FRACP, Katherine B. Frayman FRACP orcid.org/0000-0003-3479-4470 Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, AustraliaSearch for more papers by this authorColin F. Robertson MD, Colin F. Robertson MD Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, AustraliaSearch for more papers by this authorSarath C. Ranganathan PhD, Sarath C. Ranganathan PhD orcid.org/0000-0002-6975-0307 Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, AustraliaSearch for more papers by this author Shivanthan Shanthikumar FRACP, Corresponding Author Shivanthan Shanthikumar FRACP shivanthan.shanthikumar@rch.org.au orcid.org/0000-0001-6000-3180 Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, Australia Correspondence Shivanthan Shanthikumar, FRACP, Respiratory Medicine, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia. Email: shivanthan.shanthikumar@rch.org.auSearch for more papers by this authorLiam Welsh PhD, Liam Welsh PhD Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, AustraliaSearch for more papers by this authorNicole Westrupp MS, Nicole Westrupp MS Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, AustraliaSearch for more papers by this authorTheresa Cole PhD, Theresa Cole PhD Department of Paediatrics, University of Melbourne, Melbourne, Australia Allergy and Immunology, Royal Children's Hospital, Melbourne, AustraliaSearch for more papers by this authorKatherine B. Frayman FRACP, Katherine B. Frayman FRACP orcid.org/0000-0003-3479-4470 Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, AustraliaSearch for more papers by this authorColin F. Robertson MD, Colin F. Robertson MD Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, AustraliaSearch for more papers by this authorSarath C. Ranganathan PhD, Sarath C. Ranganathan PhD orcid.org/0000-0002-6975-0307 Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, AustraliaSearch for more papers by this author First published: 20 August 2020 https://doi.org/10.1002/ppul.25023Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume55, Issue11November 2020Pages 2840-2841 RelatedInformation

ObjectivesTo describe the epidemiology of lung function in Australian children aged 11–12 years and their parents, and explore the degree of intergenerational concordance.DesignCross-sectional study (the Child Health CheckPoint) nested in the Longitudinal Study of Australian Children (LSAC).SettingAssessment centres in seven Australian cities and eight regional towns, February 2015 to March 2016. Families unable to attend a clinic appointment were offered a home visit during the same period.Participants1874 families (53% of all eligible) participated in the study. Lung function data were available for 1759 children aged 11–12 years and 1774 parents (1668 biological pairs).Outcome measuresParticipants completed spirometry with measures including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and mid expiratory flow (MEF), converted to z-scores using Global Lung Initiative equations. Parent–child concordance was assessed using Pearson’s correlation coefficients and multivariable linear regression models. Survey weights and methods accounted for LSAC’s complex sampling, stratification and clustering within postcodes.ResultsAll lung function measures followed approximately normal distributions. Mean (SD) for FEV1, FVC and MEF z-scores in children were 0.33 (1.07), 0.83 (1.14) and −0.48 (1.09), respectively. Mean (SD) in parents were 0.28 (1.10), 0.85 (1.15) and −0.45 (1.10), respectively. Parent FEV1, FVC and MEF were associated with child lung function with significant positive correlation coefficients (0.22, 95% CI 0.17 to 0.26; 0.24, 95% CI 0.20 to 0.29; and 0.24, 95% CI 0.20 to 0.29, respectively).ConclusionsMean lung volumes were larger but with smaller airway size than international standards for both parents and children in this population sample. Modest associations between parent and child lung function highlight the potential for better identification of ‘at risk’ populations. Therefore, these findings may aid the development of health policy that aims to prevent the onset or limit the progression of lung disease.

Objective: To determine the health outcomes for adults aged 22-35 years old who were conceived via assisted reproduction technology (ART) compared with adults of the same age conceived without use of ART. Design: Cohort study. Setting: Not applicable. Patient(s): Adult men and women aged 22-35 years who were conceived with and without use of ART. Intervention(s): Questionnaire and clinical review. Main Outcome Measure(s): Vascular structure (carotid artery intima-media thickness, pulse wave velocity), vascular function (blood pressure), metabolic markers (fasting blood glucose, insulin, and standard lipid profiles), anthropometric measurements, and respiratory function (spirometry). Result(s): The mean age of the 193 ART and 86 non-ART participants was 27.0 and 26.9 years, respectively. There were no substantial intragroup differences in demographics or vascular intermediate phenotypes, metabolic parameters, or anthropometric measures, before or after adjusting for perinatal factors and a quality of life measure with four domains. Diastolic blood pressure was lower in the ART men than the non-ART men (adjusted mean difference -4.4 mm Hg, 95% CI, -8.7 to -0.1). The ART group reported a higher prevalence of ever having asthma, (40.8% vs. 28.6%; odds ratio 1.7; 95% CI, 1.0-3.0), but expiratory flow rates were similar. Conclusion(s): This study of the health of 193 adults conceived via ART, the largest to date globally, found no evidence of increased vascular or cardiometabolic risk, or growth or respiratory problems in the ART group compared with a non-ART group from the same source population. Follow-up observation for reproductive and later-onset adverse health effects remains important. ((C) 2019 by American Society for Reproductive Medicine.)

More than 7 million individuals have been conceived by Assisted Reproductive Technologies (ART) and there is clear evidence that ART is associated with a range of adverse early life outcomes, including rare imprinting disorders. The periconception period and early embryogenesis are associated with widespread epigenetic remodeling, which can be influenced by ART, with effects on the developmental trajectory in utero, and potentially on health throughout life. Here we profile genome-wide DNA methylation in blood collected in the newborn period and in adulthood (age 22–35 years) from a unique longitudinal cohort of ART-conceived individuals, previously shown to have no differences in health outcomes in early adulthood compared with non-ART-conceived individuals. We show evidence for specific ART-associated variation in methylation around birth, most of which occurred independently of embryo culturing. Importantly, ART-associated epigenetic variation at birth largely resolves by adulthood with no direct evidence that it impacts on development and health.

AimWe assessed the feasibility of telehealth spirometry assessments for children with cystic fibrosis (CF) living in a regional setting.MethodPatients with acceptable computer hardware at home were provided with a SpiroUSB (Vyaire) spirometer. Spirometry was performed during ‘home admissions’ or for ongoing home monitoring in children living outside metropolitan Melbourne. At the end of the session, the family forwarded the data to the Royal Children’s Hospital, Melbourne.ResultsTwenty-two patients aged 7 to 17 years participated, with spirometry successful in 55 of 59 (93%) attempted sessions according to American Thoracic Society/European Respiratory Society criteria. The median distance between the subject’s home and the hospital was 238 km (range 62–537 km) which equated to a travel time saving of 5 hours and 34 min per hospital visit.ConclusionHome-based telehealth spirometry is feasible in children with CF and can support the CF team during home-based admissions and for ongoing outpatient monitoring.

Background: Approximately 4% of babies born in Australia are conceived by assisted reproductive technologies (ART). The artificial procedures used during ART raises the risk profile of adult-onset chronic health problems, including respiratory conditions, compared with naturally conceived children. Our aim was to determine whether adults conceived by ART have altered lung function compared with age- and sex-matched controls. Methods: As part of a large cohort study in Victoria, Australia, participants performed spirometry and multiple breath nitrogen washout (MBNW) according to current ATS/ERS guidelines. These measures were done with the clinician blinded to the case or control status of the participant. Results: 165 ART-conceived participants (94 female) and 79 naturally conceived controls (53 female) completed spirometry and a subgroup of 71 (48 ART) completed MBNW. There were no differences in mean (sd) age (27.3 (2.9) vs 27.3 (2.5) years, p=0.97) or mean (sd) BMI (25.4 (5.1) vs 25.6 (4.9) kg/m2, p=0.77) between the ART and control groups. There were no significant differences between ART and control participants for any lung function measurements. ART and control participants had similar FEV1 z-scores (mean difference (95%CI) (-0.15 (-0.39 to 0.10)), FVC z-scores (-0.08 (-0.33 to 0.16)), lung clearance index (0.37 (-0.01 to 0.73)) and functional residual capacity (0.27 (-0.20 to 0.74)). Conclusions: ART-conceived adults have comparable lung function to age- and sex-matched controls.

Objective: Early life tobacco smoke exposure may influence asthma, lung function and lung function growth into adolescence. We aimed to determine the associations between perinatal smoke exposure and asthma and lung function up to 18years of age. Methods: We prospectively recorded perinatal parental smoking and measured respiratory outcomes at 12 and 18years in the Melbourne Atopy Cohort Study (MACS), a longitudinal birth cohort. Multiple logistic regression was used to analyse the associations between perinatal smoke exposure and asthma at 12 (n = 370) and 18years (n = 411). Multiple linear regression was used to investigate the relationship between perinatal smoking and: lung function (12 and 18years) and lung function growth (between 12 and 18years). Results: At 18years, girls exposed to parental smoking during the perinatal period had increased odds of asthma (OR: 3.45, 95%CI: 1.36, 8.77), reduced pre-bronchodilator Forced expiratory volume in one-second (FEV1) (-272ml/s; -438, -107); FEV1/ forced vital capacity (FVC) (-0.038; -0.065, -0.010); mid expiratory flow (MEF25-75) (-430ml/s; -798, -61), and reduced post-bronchodilator FEV1/FVC (-0.028, -0.053, -0.004). No associations were found for boys (pre-bronchodilator FEV1 26ml/s; -202, 255; FEV1/FVC 0.018; -0.013, 0.049). Conclusions: Perinatal smoke may affect risk of asthma, reduce lung function and lung function growth in adolescence. Girls appear to be more susceptible than boys.