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

Area of Science:

• Pediatric Pulmonology
• Developmental Biology
• Respiratory Medicine

Background:

• Preterm birth disrupts critical lung development, leading to long-term respiratory problems.
• Bronchopulmonary dysplasia (BPD) is a known factor, but prematurity itself significantly contributes to persistent pulmonary impairment.
• Lung function trajectories in preterm children often remain low from infancy through adulthood, increasing vulnerability to chronic airflow limitation.

Purpose of the Study:

• To highlight the substantial impact of prematurity per se on persistent pulmonary impairment in preterm-born children.
• To emphasize the need for developmentally tailored approaches to assess lung function across different age groups.
• To underscore the importance of early identification and intervention for abnormal lung function trajectories.

Main Methods:

• Utilized non-volitional techniques (tidal breathing flow-volume loops, raised-volume rapid thoracoabdominal compression) for infant lung function assessment.
• Employed impulse oscillometry for preschool children to detect small airway dysfunction.
• Applied spirometry, body plethysmography, diffusing capacity, and multiple breath washout for school-aged children and beyond.

Main Results:

• Reduced lung function is observed in preterm children, irrespective of BPD, and can persist into adulthood.
• Abnormal lung function trajectories may predispose individuals to early-onset chronic obstructive pulmonary disease (COPD)-like phenotypes.
• Early identification of abnormal lung function and risk factors is crucial for effective long-term management.

Conclusions:

• Prematurity per se is a significant contributor to long-term pulmonary impairment and chronic airflow limitation.
• Standardized, age-specific lung function assessment protocols and harmonized reference values are essential for improved risk stratification.
• Structured long-term follow-up and preventive strategies are vital to optimize respiratory outcomes in preterm-born populations.