Follow-up of neonatal chronic respiratory disease: an update based on the current evidence

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.

Keywords: Bronchopulmonary dysplasia; Childhood; Exercise limitation; Lung function; Pulmonary hypertension.