Looking beyond bronchopulmonary dysplasia: prematurity-associated lung disease and its phenotypes

Area of Science:

• Pulmonology
• Neonatology
• Pediatric Respiratory Medicine

Background:

• Preterm birth is a significant risk factor for chronic respiratory diseases throughout life.
• Historically, focus has been on extremely preterm infants and bronchopulmonary dysplasia (BPD), but other preterm groups also face lung disease risks.
• Factors beyond BPD, including gestational age and intrauterine growth restriction, contribute to lung disease in preterm infants.

Purpose of the Study:

• To introduce prematurity-associated lung disease (PLD) as a unifying concept for pulmonary consequences of preterm birth.
• To highlight diverse PLD phenotypes beyond traditional BPD.
• To establish a foundation for personalized monitoring and targeted therapies for preterm infants with lung disease.

Main Methods:

• Review and synthesis of existing literature on lung disease following preterm birth.
• Identification and characterization of distinct prematurity-associated lung disease phenotypes.
• Analysis of contributing factors and prognostic implications for each phenotype.

Main Results:

• Preterm birth is a determinant of chronic respiratory disease across the lifespan.
• Multiple phenotypes of prematurity-associated lung disease (PLD) exist, including obstructive lung disease, preserved ratio impaired spirometry, and dysanapsis.
• These phenotypes are linked to specific early-life exposures and mechanisms, impacting prognosis differently.

Conclusions:

• PLD provides a comprehensive framework for understanding the spectrum of lung disease in preterm infants.
• Recognizing distinct PLD phenotypes is crucial for developing individualized management strategies.
• Further research into these phenotypes will enable more precise monitoring and therapeutic interventions for affected children.