While medical treatment of preterm infants has vastly improved, the respiratory problems that are associated with extremely preterm birth may be a product of the early birth itself. "In theory, preterm survivors of modern neonatal care, who have been treated with ante-natal steroids and postnatal surfactant and subjected to far gentler ventilatory regimes than in the past, should have far less evidence of airway injury than their predecessors," said Dr. Stocks. "The persistence of airway obstruction in these children is likely multi-factorial in nature, potentially reflecting the impact of extreme preterm birth per se and the vulnerability of such immature lungs even to low ventilatory pressures or oxygen concentrations. It is, however, important to note that amongst the minority (29 percent) of children who survived EP birth without BPD (long-term oxygen dependency), respiratory outcome is encouraging."

Dr. Stocks further noted that "a sizeable proportion of EP children in this study may have benefited from closer surveillance and medication, particularly those with prior BPD." Among the 48 EP children with respiratory symptoms during the past 12 months, 8 (17 percent) had not received any medication. Similarly, of the 33 EP children with prior BPD who, despite being asymptomatic, had evidence of reversible airways obstruction (abnormal spirometry and a positive bronchodilator response) 19 (58 percent) were not receiving any treatment.

"These results indicate that despite improvements in obstetric and neonatal care that have resulted in increased survival of extremely preterm infants, airway obstruction remains a common long-term outcome," she said. "Children born extremely preterm remain at high risk for respiratory morbidity, airway obstruction and increased bronchial responsiveness. There needs to be long term surveillance of this population, and appropriate treatment throughout childhood with a special emphasis on a healthy lifestyle with respect to diet, exercise and smoking prevention in order to preserve available lung function for as long as possible."

SOURCE American Journal of Respiratory and Critical Care Medicine