Prematurity and Intrauterine Insults

Lung growth and pulmonary function after prematurity and bronchopulmonary dysplasia

“…Similarly, intra‐acinar arteries and veins continue to develop after birth by angiogenesis as long as the alveoli increase in number and size 15 . Blood vessel formation and alveolar growth are inter‐related processes, with the former actively promoting the latter, and contributing to maintaining the alveolar structures for the rest of an individual's life 16‐19 …”

“…According to a review and meta‐analysis on patients aged 5–23 years, the %FEV 1 deficit in those born preterm with and without BPD was about 16.8% and 7.2%, respectively 67 . Some reports reveal a gradual decline in lung function with age, raising concern that children with BPD are at higher risk of early‐onset chronic obstructive pulmonary disease (COPD) 18,68 . In a recent Australian study, Simpson et al found that preterm infants had a worrying decline in spirometric values from 4 to 12 years of age (0.1 z score per year for FEV 1 , FEF 25–75 , and FEV 1 /FVC), with the poorest trajectories in BPD survivors.…”

“… 15 Blood vessel formation and alveolar growth are inter‐related processes, with the former actively promoting the latter, and contributing to maintaining the alveolar structures for the rest of an individual's life. 16 , 17 , 18 , 19…”

“… 67 Some reports reveal a gradual decline in lung function with age, raising concern that children with BPD are at higher risk of early‐onset chronic obstructive pulmonary disease (COPD). 18 , 68 In a recent Australian study, Simpson et al found that preterm infants had a worrying decline in spirometric values from 4 to 12 years of age (0.1 z score per year for FEV 1 , FEF 25–75 , and FEV 1 /FVC), with the poorest trajectories in BPD survivors. Children with bronchial wall thickening on chest computed tomography (CT) (suggestive of inflammation), those exposed to tobacco smoke, born at earlier gestational age, or requiring more supplemental oxygen after birth showed a faster decline in FEV 1 (Figure 1 ).…”

“…Although the decline of lung function and the time at which it may occur are still a matter of debate, it is clear that preterm infants with and without BPD do not catch up to the lung function of their matched term peers, failing to reach the normal peak at 20–25 years of age and being therefore at risk for early chronic obstructive lung disease. 18 …”