Respiratory Follow Up of the Premature Neonates—Rationale and Practical Issues

Abstract

The aim of the review was to present the state of knowledge about the respiratory pathology in former premature neonates (children that were born preterm—before 37 weeks of gestation—and are examined and evaluated after 40 weeks corrected age) other than chronic lung disease, in order to provide reasons for a respiratory follow-up program for this category of patients. After a search of the current evidence, we found that premature infants are prone to long-term respiratory consequences due to several reasons: development of the lung outside of the uterus, leading to dysmaturation of the structures, pulmonary pathology due to immaturity, infectious agents or mechanical ventilation and deficient control of breathing. The medium- to long-term respiratory consequences of being born before term are represented by an increased risk of respiratory infections (especially viral) during the first years of life, a risk of recurrent wheezing and asthma and a decrease in pulmonary volumes and airway flows. Late preterm infants have risks of pulmonary long-term consequences similar to other former premature infants. Due to all the above risks, premature neonates should be followed in an organized fashion, being examined at regular time intervals from discharge from the maternity hospital until adulthood—this could lead to an early detection of the risks and preventive therapies in order to improve their prognosis and assure a normal and productive life. The difficulties related to establishing such programs are represented by the insufficient standardization of the data gathering forms, clinical examinations and lung function tests, but it is our belief that if more premature infants are followed, the experience will allow standards to be established in these fields and the methods of data gathering and evaluation to be unified.

Predictors of recurrent wheezing in late preterm infants

“…Late preterm infants, those born between 32 and 36 weeks gestational age, are less likely to develop BPD; however, these infants are still at an increased risk of adverse respiratory outcomes 5 . Chief among these is the development of bronchial hyperactivity presenting as isolated or recurrent wheezing and later development of asthma 5,6 . A previous systematic review found an increased risk of wheezing disorders in preterm babies, with an inverse correlation between gestational age at birth and the risk of wheezing 6 .…”

“…5 Chief among these is the development of bronchial hyperactivity presenting as isolated or recurrent wheezing and later development of asthma. 5,6 A previous systematic review found an increased risk of wheezing disorders in preterm babies, with an inverse correlation between gestational age at birth and the risk of wheezing. 6 Another study found that more than 54% of infants born at 32-36 weeks gestation had a physician diagnosis of wheezing within the first 3 years of life, with nearly half of these infants having recurrent wheezing.…”

“…5,6 A previous systematic review found an increased risk of wheezing disorders in preterm babies, with an inverse correlation between gestational age at birth and the risk of wheezing. 6 Another study found that more than 54% of infants born at 32-36 weeks gestation had a physician diagnosis of wheezing within the first 3 years of life, with nearly half of these infants having recurrent wheezing. 7 Compared to term infants, this wheezing results in increased healthcare utilization and respiratory morbidity.…”

Relationship between mechanical ventilation at birth and respiratory tract infections within one year of follow-up in preterm infants

“…With the current medical technology, mild ventilation techniques can be used to sustain the lives of preterm infants at a lower gestational age (GA). [2,3] Although MV can improve oxygenation and reduce mortality, it is also associated with various complications, including chronic lung injury. [4] Previous studies have mainly focused on the relationships among MV, bronchopulmonary dysplasia (BPD), and lung function.…”

An Update on Lung Function of Extremely and Very Preterm Infants in Later Life: The Role of Early Nutritional Interventions

“…Previous longitudinal pulmonary function and long-term follow-up studies reported that most extremely/very preterm neonates with BPD present with a low lung function trajectory [13,14] and an increased risk for the future development of a chronic obstructive pulmonary disease (COPD)-like phenotype [15][16][17]. Furthermore, former extremely/very premature infants are predisposed to the development of other respiratory morbidities than chronic lung disease, due to factors associated with prematurity [18]. These infants present with a higher incidence of lower respiratory tract infections requiring re-hospitalizations, impaired lung mechanics, and developmental abnormalities of the airways, leading to recurrent wheezing and asthma.…”