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[Pulmonary prognosis in preterm infants]
Luciana Friedrich1, Andréa L Corso, Marcus H Jones
1Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS.
Insights
Premature birth permanently alters respiratory system development, leading to chronic lung diseases like bronchopulmonary dysplasia and persistent functional deficits into adolescence.
Area of Science:
- Pulmonary Medicine
- Neonatology
- Pediatric Pulmonology
Context:
- Increased survival rates of preterm infants present ongoing challenges with chronic respiratory conditions.
- Preterm infants face a spectrum of pulmonary issues, including bronchopulmonary dysplasia, Wilson-Mikity syndrome, and recurrent wheezing.
Purpose:
- To review the pulmonary clinical and functional prognosis of preterm infants from infancy through adolescence.
- To synthesize findings on lung growth, function, and clinical outcomes in this population.
Summary:
- Prenatal and postnatal factors significantly impact lung development, increasing risks for chronic lung disease, with bronchopulmonary dysplasia as a severe complication.
- Even preterm infants without severe neonatal respiratory disease experience substantial lung function loss, often underestimated.
- Clinical manifestations include increased pneumonia, bronchiolitis, hospital readmissions, chronic cough, wheezing, and bronchial hyperresponsiveness.
Impact:
- Prematurity and associated perinatal events induce lasting changes in respiratory system development.
- Adolescents born preterm often show normalized lung function but retain reduced airflow, decreased exercise tolerance, and bronchial hyperresponsiveness.
- Further research is needed to elucidate the specific effects of various perinatal insults on respiratory development.
Objective:
The increased survival of preterm infants poses the challenge of dealing with a wide range of chronic pulmonary diseases, including bronchopulmonary dysplasia, Wilson-Mikity syndrome and recurrent wheezing. This article reviews the pulmonary clinical and functional prognosis of preterm newborns in infancy and adolescence.
Source Of Data:
MEDLINE search for articles published between 1970 and 2004 that focused on lung growth and function of preterm infants, besides a clinical follow-up of this group.
Summary Of The Findings:
Prenatal and postnatal events, such as placental insufficiency, tobacco exposure, infections, oxygen and mechanical ventilation, have an important effect on lung development and can lead to chronic lung diseases, of which bronchopulmonary dysplasia is the most severe complication. However, significant loss of lung function occurs in preterm infants who do not fulfill the criteria for bronchopulmonary dysplasia, and even in those who did not have significant respiratory disease during the neonatal period. The impact of prematurity on the respiratory system of these patients is usually underestimated. Clinically, preterm infants have an increased incidence of pneumonia and bronchiolitis, hospital readmissions due to respiratory diseases, chronic cough and wheezing and bronchial hyperresponsiveness. In adolescence, there is a tendency for normalization of the lung function, but they persist with reduced flows, lower exercise tolerance and bronchial hyperresponsiveness.
Conclusions:
Prematurity, the events that cause it and the interventions that follow it permanently change the development of the respiratory system. Studies are necessary to clarify the effect of each of these perinatal insults on the development of the respiratory system.
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