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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, or birth before 37 weeks, leads to long-term respiratory issues in children and adults. Early life lung development impacts adult respiratory health, necessitating targeted research and management strategies.
Area of Science:
- Neonatology
- Pulmonology
- Public Health
Background:
- Prematurity (<37 weeks gestation) affects over 50,000 UK births annually, posing significant risks.
- Preterm birth is linked to persistent respiratory symptoms and impaired lung function into adulthood.
- Current adult respiratory care often overlooks neonatal history, lacking evidence-based management for these individuals.
Purpose of the Study:
- To highlight the long-term respiratory consequences of prematurity.
- To emphasize the need for understanding the underlying mechanisms of these respiratory issues.
- To advocate for optimized treatment strategies and research priorities for preterm-born individuals.
Main Methods:
- Review of existing literature on the long-term respiratory outcomes of preterm birth.
- Analysis of the association between prematurity and respiratory symptoms, airflow obstruction, and thoracic imaging abnormalities.
- Discussion of current clinical practices and evidence gaps in adult respiratory medicine concerning preterm-born individuals.
Main Results:
- Preterm birth is associated with increased respiratory symptoms and airflow obstruction persisting into childhood and adulthood.
- Individuals born preterm may not achieve optimal peak lung function, raising concerns for accelerated decline.
- Adults born preterm are often misdiagnosed with asthma, masking distinct underlying pathophysiological mechanisms.
Conclusions:
- Prematurity has significant, lasting impacts on respiratory health, extending into adulthood.
- There is a critical need for adult respiratory physicians to consider neonatal history in patient assessment.
- Further research is essential to elucidate mechanisms and develop effective, tailored treatments for the respiratory sequelae of prematurity.
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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