Lung Health after Preterm Birth: Knowledge Gaps and Respiratory Care Across the Lifespan

Prematurity affects approximately 10% of live births worldwide and contributes to substantial short and long-term morbidity, particularly respiratory disease. Approximately 35% of infants born before 32 weeks gestation are diagnosed with bronchopulmonary dysplasia (BPD). Many preterm infants regardless of BPD diagnosis also develop respiratory problems in both childhood and adulthood, more recently termed as prematurity-associated lung disease (PLD). As survival of preterm infants continues to improve, the lifetime burden of PLD and related health conditions remains high. Optimizing lung growth, minimizing the impact of comorbidities, and improving quality of life are ongoing challenges. Individuals born preterm are also at higher risk for being diagnosed with early-onset chronic obstructive pulmonary disease in adulthood. Despite these public health implications, outpatient management is often variable, and PLD remains underrecognized and heterogeneous across clinical settings. In this expert consensus statement from the BPD Collaborative, we summarize key knowledge gaps and provide pragmatic recommendations to help standardize outpatient care for PLD across the lifespan. Recommendations address models of care delivery, approaches to disease monitoring and management, and the evaluation and treatment of common comorbidities. Given limited high-quality evidence in several domains, many recommendations are necessarily based on expert opinion. Our objectives are to highlight priorities for future research, promote continuity between pediatric and adult care, and support development of evidence-based strategies to reduce underdiagnosis and undertreatment and to improve long-term outcomes for individuals born preterm.