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Published on: November 20, 2015
Pulmonary and neurological follow-up of extremely preterm infants
Lex W Doyle1, Peter J Anderson
1Department of Obstetrics and Gynaecology, The Royal Women's Hospital, University of Melbourne, and Murdoch Children's Research Institute, Parkville, Vic., Australia. lwd@unimelb.edu.au
Insights
Infants born extremely preterm (<28 weeks
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Neurodevelopmental Pediatrics
Background:
- Increasing survival rates for extremely preterm (EP) infants (<28 weeks' gestation) highlight the need to understand long-term health consequences.
- EP infants frequently experience immediate pulmonary issues, requiring respiratory support and often developing bronchopulmonary dysplasia or long-term oxygen dependency.
- The transition from the uterus to an external environment poses significant neurological challenges, leading to higher incidences of cerebroventricular hemorrhage and white matter injury in EP survivors compared to term-born infants.
Purpose of the Study:
- To investigate the long-term pulmonary, neurological, and developmental outcomes for infants born extremely preterm.
- To compare the health trajectories of EP survivors with those of children born at term.
Main Methods:
- Observational study analyzing long-term health data of extremely preterm infants.
- Comparative analysis of pulmonary function, neurological development, and cognitive/behavioral assessments between EP survivors and term-born controls.
Main Results:
- EP survivors exhibit increased rates of respiratory illnesses, reduced pulmonary function (airway obstruction), and lower exercise tolerance in childhood.
- Higher prevalence of significant developmental delay, motor impairments, learning disabilities, and behavioral problems are observed in EP children.
- Despite challenges, a majority of EP survivors do not develop severe long-term pulmonary or neurological deficits.
Conclusions:
- Extreme prematurity is associated with a spectrum of chronic health issues, including respiratory and neurodevelopmental impairments, extending into childhood.
- Early identification and management of these complications are crucial for improving long-term outcomes in EP survivors.
- While significant challenges exist, most extremely preterm infants achieve reasonable long-term health without major pulmonary or neurological sequelae.
Abstract:
The long-term consequences of extreme prematurity assume more importance as survival rates increase. Pulmonary problems are common immediately after birth and most extremely preterm (EP) infants (<28 weeks' gestation) require respiratory support. Many survivors develop bronchopulmonary dysplasia and some have long-term oxygen dependency, occasionally for years. Their brain has to respond to an environment very different to that of the uterus, and cerebroventricular haemorrhage and white matter injury occur much more frequently than in term infants. Compared with children born at term, EP survivors have higher rates of wheezing and hospital readmission for respiratory illnesses in the first few years after the primary hospitalisation. As they grow older they have reduced pulmonary function, particularly airway obstruction, and lower exercise tolerance. Larger proportions of EP children have significant developmental and motor delay in early childhood. At school age other cognitive impairments including learning disabilities and behavioural problems occur more frequently. Despite these difficulties, most EP survivors escape without major long-term pulmonary or neurological problems.
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