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Follow-up of neonatal chronic respiratory disease: an update based on the current evidence
Allan Jenkinson1, Theodore Dassios2,3,4
1Department of Women and Children's Health, School of Life Sciences, Faculty of Life Science and Medicine, King's College London, London, UK.
Insights
Cardiorespiratory follow-up for extremely preterm infants, especially those with bronchopulmonary dysplasia, needs to extend into early adulthood. Assessments should include lung function, vascular disease, and exercise testing for targeted interventions.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Cardiorespiratory Medicine
Background:
- Premature birth leads to chronic respiratory morbidity affecting airway function, lung parenchyma, and cardiac morphology.
- This morbidity persists into childhood, adolescence, and adulthood, with a lack of evidence-based guidelines for long-term follow-up.
- Existing follow-up often ceases by age two, primarily assessing lung function, but misses other critical cardiorespiratory aspects.
Purpose of the Study:
- To provide an updated review of current evidence regarding cardiorespiratory follow-up for extremely preterm infants.
- To highlight the need for extended and comprehensive follow-up protocols, particularly for infants with bronchopulmonary dysplasia.
- To emphasize the complex, multisystem nature of respiratory disease post-preterm birth.
Main Methods:
- Narrative review of current evidence on cardiorespiratory follow-up for extremely preterm infants.
- Analysis of existing literature on the long-term cardiorespiratory outcomes in this population.
- Synthesis of findings to propose recommendations for future follow-up strategies.
Main Results:
- Significant variation exists in the frequency, components, and duration of current follow-up practices.
- Studies beyond two years of age primarily focus on spirometry for lung function impairment.
- Recent evidence identifies distinct phenotypes of respiratory disease, including pulmonary vascular disease, parenchymal abnormalities, and impaired cardiorespiratory fitness.
Conclusions:
- Follow-up should extend to early adulthood to capture the full spectrum of cardiorespiratory complications.
- Comprehensive assessments should include lung function, pulmonary vascular disease, parenchymal disease, and cardiorespiratory exercise testing.
- Individualized, targeted interventions are needed based on the dominant pathophysiological process identified during follow-up.
Abstract:
Chronic respiratory morbidity following premature birth is associated with significant and long-standing complications affecting airway function, the lung parenchyma and cardiac morphology. The aim of this narrative review was to provide an update on the current evidence for the cardiorespiratory follow-up of extremely preterm infants, particularly those with bronchopulmonary dysplasia. There is currently wide variation in the frequency, components and duration in the follow-up of these infants and an absence of robust evidence to support specific recommendations. Follow-up is most commonly offered up to 2 years of age, and studies beyond this age primarily report spirometric indices to quantify lung function impairment and abnormal respiratory trajectories. Recent evidence has highlighted distinct phenotypes and the complex multisystem nature of respiratory disease following preterm birth, which includes patterns of persistent pulmonary vascular disease, abnormal parenchymal function and impaired cardiorespiratory fitness.
Conclusion:
We suggest that follow-up of these infants should extend in time to early adulthood and focus on capturing and describing not only lung function test abnormalities but also include pulmonary vascular disease, parenchymal disease and cardiorespiratory exercise testing with a view to identify individuals who would benefit most from targeted interventions based on the dominant pathophysiological process at an individual level.
What Is Known:
• Preterm birth is associated with significant respiratory morbidity lasting into childhood, adolescence, and adulthood. • There is a lack of sufficient high-level evidence to inform how these infants should be followed up in childhood and beyond.
What Is New:
• Other than lung function abnormalities, preterm-born children and adults have parenchymal lung damage, pulmonary vascular disease and exercise limitation. • Follow-up of individuals with significant neonatal respiratory disease should expand beyond early childhood and include more extensive cardiorespiratory assessments.
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