Bronchopulmonary dysplasia as a determinant of respiratory outcomes in adult life

Abstract

Respiratory disease is unfortunately common in preterm infants with the archetype being bronchopulmonary dysplasia (BPD). BPD affects approximately 50,000 preterm infants in the U.S. annually with substantial morbidity and mortality related to its pathology (alveolar, airway, and pulmonary vasculature maldevelopment). Predicting the likelihood and severity of chronic respiratory disease in these children as they age is difficult and compounded by the lack of consistent phenotyping. Barriers to understanding the actual scope of this problem include few longitudinal studies, information limited by small retrospective studies and the ever‐changing landscape of therapies in the NICU that affect long‐term respiratory outcomes. Thus, the true burden of adult respiratory disease caused by premature birth is currently unknown. Nevertheless, limited data suggest that a substantial percentage of children with a history of BPD have long‐term respiratory symptoms and persistent airflow obstruction associated with altered lung function trajectories into adult life. Small airway disease with variable bronchodilator responsiveness, is the most common manifestation of lung dysfunction in adults with a history of BPD. The etiology of this is unclear however, developmental dysanapsis may underlie the airflow obstruction in some adults with a history of BPD. This type of flow limitation resembles that of aging adults with chronic obstructive lung disease with no history of smoking. It is also unclear whether lung function abnormalities in people with a history of BPD are static or if these individuals with BPD have a more accelerated decline in lung function as they age compared to controls. While some of the more significant mediators of lung function, such as tobacco smoke and respiratory infections have been identified, more work is necessary to identify the best means of preserving lung function for individuals born prematurely throughout their lifespan.

Compatibility of rapid enteral feeding advances and noninvasive ventilation in preterm infants—An observational study

“…This is of special interest, because preterm infants accumulate significant growth deficits by the time of discharge from hospital 31,32 that persist through infancy and early childhood into adolescence. 33,34 Our subgroup analyses prevailed that ELBW and SGA infants with the highest risk for growth deviations benefited in somatic growth when their feedings are advanced rapidly using STENA. Additionally, our ROC analysis calculation indicates that standardized and progressive feeding works even…”

Influences of environmental exposures on preterm lung disease

“…The likelihood of adverse outcomes with respiratory viral infections in infancy is increased with a history of preterm lung disease [94]. Respiratory infections may alter subsequent lung function through adverse effects on immune responses, chronic pathogen colonization, or microbiome changes, and injury repair [95]. A national study from Taiwan reported that a history of BPD was associated with a 1.8-14.4-fold increased risk of hospitalization for respiratory syncytial virus (RSV) compared to gestation and age-matched controls [80].…”

Corticosteroids in the prevention and treatment of infants with bronchopulmonary dysplasia: Part II. Inhaled corticosteroids alone or in combination with surfactants

“…Bronchopulmonary dysplasia (BPD) has remained the most significant respiratory complication of prematurity more than 50 years after its original description by Northway et al 1 Since then the clinical course of BPD has become milder due to the significant development in the management of premature infants, 2,3 however, the manifestations of this chronic respiratory disease may persist through the lifespan and can be detected on various measures of lung function 4 . Although anti‐inflammatory corticosteroids (CSs) have long been used for the prevention and treatment of BPD, their therapeutic efficacy and long‐term neurodevelopmental and respiratory consequences still need to be evaluated 2,3 …”