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Paediatric Pulmonology and Allergology
2007 October, Vol. X, No. 2 (3617-3640)
LESSONS OF FOLLOW-UP CHILDREN WITH BRONCHOPULMONARY DYSPLASIA
Andrew Bush
Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
Advances in neonatal care over the last three decades have resulted in extremely preterm infants surviving, but with adverse consequences, some of which can be attributed to the very treatments that allow survival. The cardiorespiratory morbidity described above likely represents an underestimate of the true prevalence. Preterm birth is associated with adverse neurodevelopmental outcomes (which have not been discussed here) and the majority of these studies excluded those with such an outcome because of an inability to perform the tests required to establish the level of function. Since abnormal neurodevelopmental outcome can also be associated with respiratory disease, the true prevalence of respiratory morbidity in ex-preterm survivors may be difficult to establish. The residual respiratory problems of preterm, low birthweight infants following discharge from neonatal intensive care include cough and wheeze, which may be associated with abnormal lung function, including airways obstruction and hyperinflation. There is also evidence of airway hyperresponsiveness, to direct stimuli and exercise but the pathophysiological basis for this remains to be established. There is evidence of impaired cardioventilatory performance during exercise, even in asymptomatic individuals. Some of these problems improve with age and somatic growth but in some individuals, they are persistent. Although those who required a high level of intensive care and subsequently develop chronic lung disease are more likely to be affected beyond infancy, these adverse affects are also observed in preterm babies who did not develop initial severe respiratory distress and will therefore require ongoing surveillance.