Lung Function Trajectories After Preterm Birth: A Life-Course Approach to Age-Specific Monitoring

Preterm birth interrupts critical phases of lung development and is associated with long-term alterations in respiratory structure and function. While bronchopulmonary dysplasia (BPD) has traditionally been considered the principal determinant of adverse outcomes, accumulating evidence indicates that prematurity per se contributes substantially to persistent pulmonary impairment. Lung function trajectories in preterm-born children frequently track along lower percentiles from infancy into adolescence and early adulthood, with limited catch-up growth and increased vulnerability to chronic airflow limitation. Assessment of lung function requires a developmentally tailored approach, as feasibility and interpretability vary across age groups. In infancy, non-volitional techniques such as tidal breathing flow-volume loop analysis and raised-volume rapid thoracoabdominal compression allow early evaluation of respiratory mechanics. During toddlerhood, methodological limitations persist, although emerging technologies may expand feasibility. In preschool children, impulse oscillometry enables detection of small airway dysfunction, often preceding spirometric abnormalities. From school age onward, spirometry, body plethysmography, diffusing capacity, and multiple breath washout provide complementary information on obstructive, restrictive, and gas-exchange impairments. Longitudinal studies demonstrate that reduced lung function is not confined to children with BPD and may predispose to early-onset chronic obstructive pulmonary disease-like phenotypes. Early identification of abnormal trajectories and modifiable risk factors supports structured long-term follow-up and preventive strategies. Standardization of age-specific assessment protocols and harmonization of reference values are essential to improve risk stratification and optimize long-term respiratory outcomes in this vulnerable population.