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The developing immune system in preterm born infants: From contributor to potential solution for respiratory tract
Inger C van Duuren1,2, Oscar R J van Hengel3, John Penders4
1Department of Paediatrics, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.
Insights
Moderate-late preterm infants face higher risks of respiratory infections and wheezing. Understanding their immune system and microbiome is key to developing preventative strategies for better long-term respiratory health.
Area of Science:
- Pediatrics
- Immunology
- Microbiome Research
Background:
- Moderate-late preterm infants (80% of preterm births) have increased respiratory morbidity compared to term infants.
- Underlying mechanisms for preterm infant respiratory issues are poorly understood, impacting long-term health (asthma, COPD).
- Early respiratory health is critical for quality of life and reducing healthcare costs in infancy.
Purpose of the Study:
- To review risk factors and preventative measures for respiratory tract infections and wheezing in preterm infants.
- To explore the impact of early life factors on the immune system and microbiome development.
- To identify strategies for optimizing immune development and respiratory health in this vulnerable population.
Main Methods:
- Literature review focusing on moderate-late preterm infants.
- Analysis of risk factors: antibiotic use, birth mode, feeding, environment.
- Examination of immune system maturation (innate and adaptive) and lung immune responses.
- Exploration of preventative strategies including microbiome interventions and immune modulation.
Main Results:
- Preterm infants exhibit distinct immune maturation and local lung immune reactions compared to term infants.
- Early life factors significantly influence immune and microbiome development, affecting respiratory outcomes.
- Various preventative strategies show promise in mitigating respiratory risks.
Conclusions:
- Optimizing immune development and respiratory health in preterm infants requires understanding their unique immunological and microbiological profiles.
- Targeted interventions addressing early life exposures and immune modulation are crucial.
- Further research is needed to translate findings into effective clinical practices for preterm infant respiratory care.
Abstract:
Moderate-late preterm-born infants experience more frequent and severe respiratory tract infections and wheezing compared to term-born infants. Decreasing the risk on respiratory tract infections and wheezing in this group is vital to improve quality of life and reduce medical consumption during infancy, but also to reduce the risk on asthma and COPD later in life. Until now, moderate-late preterm infants are underrepresented in research and mechanisms underlying their morbidity are largely unknown, although they represent 80% of all preterm-born infants. In order to protect these infants effectively, it is essential to understand the role of the immune system in early life respiratory health and to identify strategies to optimize immune development and respiratory health. This review elaborates on risk factors and preventative measures concerning respiratory tract infections and wheezing in preterm-born infants, exploring their impact on the immune system and microbiome. Factors discussed are early life antibiotic use, birth mode, feeding type and living environment. Further, differences in adaptive and innate immune maturation between term and preterm infants are discussed, as well as differences in local immune reactions in the lungs. Finally, preventative strategies are being explored, including microbiota transplantation, immune modulation (through pre-, pro-, syn- and postbiotics, bacterial lysates, vaccinations, and monoclonal antibodies) and antibiotic prophylaxis.
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