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Published on: November 20, 2015
Lung consequences in adults born prematurely
Charlotte E Bolton1, Andrew Bush2, John R Hurst3
1Nottingham Respiratory Research Unit, School of Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK Department of Respiratory Medicine, Nottingham University Hospitals Trust, Nottingham, UK.
Insights
Prematurity increases the risk of long-term respiratory issues in children and young adults. Early intervention and lifestyle changes are crucial for managing lung health in individuals born preterm.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Adult Respiratory Medicine
Background:
- Prematurity (<37 weeks gestation) is a significant cause of infant mortality and morbidity, affecting over 50,000 UK births annually.
- Preterm birth is linked to persistent respiratory symptoms, airflow obstruction, and abnormal thoracic imaging throughout childhood and young adulthood.
- Optimal peak lung function may not be achieved, raising concerns about accelerated decline and earlier onset of respiratory symptoms.
Purpose of the Study:
- To highlight the long-term respiratory consequences of prematurity.
- To emphasize the lack of specific adult care guidelines for individuals born preterm.
- To identify clinical and research priorities for improving long-term lung health in this population.
Main Methods:
- This study is a review of existing literature and clinical observations.
- It synthesizes data on the respiratory outcomes of preterm infants into adulthood.
- It discusses current clinical practices and identifies gaps in management.
Main Results:
- Individuals born preterm experience increased respiratory symptoms and airflow obstruction compared to term-born individuals.
- Adult respiratory physicians often overlook the neonatal history in clinical assessments.
- Current management strategies are largely extrapolated from other airway diseases, lacking specific evidence.
Conclusions:
- There is a critical need to understand the unique respiratory mechanisms in adults born preterm.
- Optimizing treatment requires evidence-based approaches tailored to this population.
- Promoting healthy lifestyle choices like smoking cessation and fitness is vital for long-term respiratory health.
Abstract:
Although survival has improved significantly in recent years, prematurity remains a major cause of infant and childhood mortality and morbidity. Preterm births (<37 weeks of gestation) account for 8% of live births representing >50 000 live births each year in the UK. Preterm birth, irrespective of whether babies require neonatal intensive care, is associated with increased respiratory symptoms, partially reversible airflow obstruction and abnormal thoracic imaging in childhood and in young adulthood compared with those born at term. Having failed to reach their optimal peak lung function in early adulthood, there are as yet unsubstantiated concerns of accelerated lung function decline especially if exposed to noxious substances leading to chronic respiratory illness; even if the rate of decline in lung function is normal, the threshold for respiratory symptoms will be crossed early. Few adult respiratory physicians enquire about the neonatal period in their clinical practice. The management of these subjects in adulthood is largely evidence free. They are often labelled as asthmatic although the underlying mechanisms are likely to be very different. Smoking cessation, maintaining physical fitness, annual influenza immunisation and a general healthy lifestyle should be endorsed irrespective of any symptoms. There are a number of clinical and research priorities to maximise the quality of life and lung health in the longer term not least understanding the underlying mechanisms and optimising treatment, rather than extrapolating from other airway diseases.
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