Chronic Lung Disease of Prematurity: Long-Term Respiratory Outcome

Abstract

Chronic respiratory morbidity is a common adverse outcome of preterm birth, especially in infants who develop bronchopulmonary dysplasia (BPD), which is still a major cause of long-term lung dysfunction with a heavy burden on health care services and medical resources throughout childhood. The most severely affected patients remain symptomatic even in adulthood, and this may be influenced also by environmental variables (e.g. smoking), which can contribute to persistent obstruction of airflow. Of all obstructive lung diseases in humans, BPD has the earliest onset and probably lasts the longest. Since the prevention of BPD is an elusive goal, minimizing neonatal lung injury and closely monitoring survivors remain the best courses of action. This review describes the clinical and functional changes characteristic of the long-term pulmonary sequelae of preterm birth, focusing particularly on BPD.

Prematurity and the burden of influenza and respiratory syncytial virus disease

“…[4] Chronic respiratory morbidity is a common adverse outcome of preterm infants who developed BPD, which is still a major cause of long-term lung dysfunction with a heavy burden on health care services and medical resources throughout childhood. [5] BPD makes infants particularly susceptible to lower respiratory tract diseases in childhood, as well as promoting chronic airflow obstruction in adulthood, commonly leading to conditions such as recurrent bronchospasm. The degree of airflow limitation in the first years of life is a good predictor of future lung function.…”

“…[9] Although an improvement in lung function is usually detectable in children whose clinical condition improves as they grow older, there may still be signs of poor airway growth when they reach school age, especially in children whose respiratory symptoms continue to recur. [5] Gas transfer also remains abnormal in young children who have experienced BPD; it is characterized by a lower than normal gas transfer and alveolar volume at rest, and their failure to increase during exercise, suggesting that the alveolar surface area is reduced. [10] At least half of all children with a history of BPD exhibit laboratory evidence of airway hyperresponsiveness to direct stimuli and to physical exercise, even if they have no clinical history of wheezing or reactive airway disease.…”

“…[10] At least half of all children with a history of BPD exhibit laboratory evidence of airway hyperresponsiveness to direct stimuli and to physical exercise, even if they have no clinical history of wheezing or reactive airway disease. [5] The long-term effects of BPD are still poorly understood. Although respiratory symptoms become milder as they grow up, BPD survivors may reveal persistent pulmonary abnormalities on computed tomography scanning.…”

“…Thus, the long-term respiratory consequences of a preterm birth may be underestimated or overlooked by providers of adult healthcare. [5] A systematic review and meta-analysis on the association of preterm birth and childhood wheezing…”

Plasma Proendothelin-1 as an Early Marker of Bronchopulmonary Dysplasia

“…Bronchopulmonary dysplasia (BPD) is a common complication of premature birth with important long-term consequences for the increasing number of very preterm infants who survive [1]. Endothelin-1 (ET-1) is an endogenous vasoconstrictive peptide, which is involved in the pathogenesis of various lung disorders such as pulmonary hypertension, acute respiratory failure and pulmonary fibrosis [2].…”