Skip to main content

Why Do Preterm Infants Wheeze? Clues from Epidemiology

  • 744 Accesses

Part of the Respiratory Medicine book series (RM)

Abstract

In this chapter, we discuss respiratory outcomes of preterm infants and the impact later in life of bronchopulmonary dysplasia (BPD). After the neonatal period, the major respiratory problems of preterm-born infants (with or without BPD) that require hospitalization are respiratory exacerbations caused by infections, particularly viral infections. In older children who were born prematurely, the most common symptoms are coughing, wheezing, and/or other asthma-like symptoms. Overall, in comparison to full-term born children, the risk of preterm-born children developing asthma or a wheezing disorder during childhood is almost twice as high. Patients are, however, often labeled asthmatic even though the underlying mechanisms are likely to be very different. There is no evidence of the widespread use of bronchodilators or inhaled corticosteroids, although a component of variable airflow obstruction may be present. To achieve optimal treatment, additional evidence is required. In order to prevent either over- or undertreatment, it is important to characterize diseases of the airways in the survivors of preterm birth. This is done in terms of the extent and nature of airflow obstruction, the pattern of any inflammation, and the presence of airway reactivity. Symptoms become milder as children grow older. Nevertheless, a group of adolescents and adults remains, who still present with chronic airway obstruction defined by recurrent episodes of wheezing and decreased lung function tests, that is, decreased forced expiratory volume. The risk of wheezing disorders increases as the degree of prematurity increases. Putative mechanisms for wheezing may include early lung injury or maldevelopment during infancy, respiratory infections during the first year of life, and structural changes of the lung parenchyma.

Keywords

  • Respiratory symptoms
  • Wheeze
  • Dyspnea
  • Retractions
  • Outcome
  • Airway
  • Hyperresponsiveness
  • Airflow obstruction
  • Maldevelopment
  • Structural changes
  • Epidemiology

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-319-48835-6_2
  • Chapter length: 15 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   109.00
Price excludes VAT (USA)
  • ISBN: 978-3-319-48835-6
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   139.99
Price excludes VAT (USA)
Hardcover Book
USD   139.99
Price excludes VAT (USA)

References

  1. Shennan AT, Dunn MS, Ohlsson A, Lennox K, Hoskins EM. Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. Pediatrics. 1988;82(4):527–32.

    CAS  PubMed  Google Scholar 

  2. Walsh MC, Yao Q, Gettner P, Hale E, Collins M, Hensman A, et al. Impact of a physiologic definition on bronchopulmonary dysplasia rates. Pediatrics. 2004;114(1098–4275; 5):1305–11.

    CrossRef  PubMed  Google Scholar 

  3. Lawn JE, Blencowe H, Oza S, You D, Lee AC, Waiswa P, et al. Every newborn: progress, priorities, and potential beyond survival. Lancet. 2014;384(9938):189–205.

    CrossRef  PubMed  Google Scholar 

  4. Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379(9832):2162–72.

    CrossRef  PubMed  Google Scholar 

  5. Gibson AM, Doyle LW. Respiratory outcomes for the tiniest or most immature infants. Semin Fetal Neonatal Med. 2014;19(2):105–11.

    CrossRef  PubMed  Google Scholar 

  6. Hamilton BE, Martin JA, Osterman MJ, Curtin SC, Matthews TJ. Births: final data for 2014. Natl Vital Stat Rep. 2015;64(12):1–64.

    Google Scholar 

  7. Gluckman PD, Hanson MA, Cooper C, Thornburg KL. Effect of in utero and early-life conditions on adult health and disease. N Engl J Med. 2008;359(1):61–73.

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

  8. Stocks J, Hislop A, Sonnappa S. Early lung development: lifelong effect on respiratory health and disease. Lancet Respir Med. 2013;1(9):728–42.

    CrossRef  PubMed  Google Scholar 

  9. Been JV, Lugtenberg MJ, Smets E, van Schayck CP, Kramer BW, Mommers M, et al. Preterm birth and childhood wheezing disorders: a systematic review and meta-analysis. PLoS Med. 2014;11(1):e1001596.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  10. Adil E, Rager T, Carr M. Location of airway obstruction in term and preterm infants with laryngomalacia. Am J Otolaryngol. 2012;33(4):437–40.

    CrossRef  PubMed  Google Scholar 

  11. Roksund OD, Clemm H, Heimdal JH, Aukland SM, Sandvik L, Markestad T, et al. Left vocal cord paralysis after extreme preterm birth, a new clinical scenario in adults. Pediatrics. 2010;126(6):e1569–77.

    CrossRef  PubMed  Google Scholar 

  12. Van Marter LJ. Epidemiology of bronchopulmonary dysplasia. Semin Fetal Neonatal Med. 2009;14(6):358–66.

    CrossRef  PubMed  Google Scholar 

  13. Patel RM, Kandefer S, Walsh MC, Bell EF, Carlo WA, Laptook AR, et al. Causes and timing of death in extremely premature infants from 2000 through 2011. N Engl J Med. 2015;372(4):331–40.

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

  14. Northway Jr WH, Rosan RC, Porter DY. Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Engl J Med. 1967;276(0028–4793; 7):357–68.

    CrossRef  PubMed  Google Scholar 

  15. Jobe AJ. The new BPD: an arrest of lung development. Pediatr Res. 1999;46(0031–3998; 6):641–3.

    CAS  CrossRef  PubMed  Google Scholar 

  16. Bancalari E, Claure N, Sosenko IR. Bronchopulmonary dysplasia: changes in pathogenesis, epidemiology and definition. Semin Neonatol. 2003;8(1):63–71.

    CrossRef  PubMed  Google Scholar 

  17. Northway Jr WH, Moss RB, Carlisle KB, Parker BR, Popp RL, Pitlick PT, et al. Late pulmonary sequelae of bronchopulmonary dysplasia. N Engl J Med. 1990;323(0028–4793; 26):1793–9.

    CrossRef  PubMed  Google Scholar 

  18. Doyle LW, Faber B, Callanan C, Freezer N, Ford GW, Davis NM. Bronchopulmonary dysplasia in very low birth weight subjects and lung function in late adolescence. Pediatrics. 2006;118(1098–4275; 1):108–13.

    CrossRef  PubMed  Google Scholar 

  19. Vrijlandt EJ, Gerritsen J, Boezen HM, Grevink RG, Duiverman EJ. Lung function and exercise capacity in young adults born prematurely. Am J Respir Crit Care Med. 2006;173(8):890–6.

    CrossRef  PubMed  Google Scholar 

  20. Watts JL, Ariagno RL, Brady JP. Chronic pulmonary disease in neonates after artificial ventilation: distribution of ventilation and pulmonary interstitial emphysema. Pediatrics. 1977;60(3):273–81.

    CAS  PubMed  Google Scholar 

  21. Hofhuis W, Huysman MW, van der Wiel EC, Holland WP, Hop WC, Brinkhorst G, et al. Worsening of V’maxFRC in infants with chronic lung disease in the first year of life: a more favorable outcome after high-frequency oscillation ventilation. Am J Respir Crit Care Med. 2002;166(12):1539–43.

    CrossRef  PubMed  Google Scholar 

  22. Kinsella JP, Greenough A, Abman SH. Bronchopulmonary dysplasia. Lancet. 2006;367(9520):1421–31.

    CrossRef  PubMed  Google Scholar 

  23. Khemani E, McElhinney DB, Rhein L, Andrade O, Lacro RV, Thomas KC, et al. Pulmonary artery hypertension in formerly premature infants with bronchopulmonary dysplasia: clinical features and outcomes in the surfactant era. Pediatrics. 2007;120(6):1260–9.

    CrossRef  PubMed  Google Scholar 

  24. Lenfant C. Lung biology in health and disease. New York: Marcel Dekker Inc.; 2000.

    Google Scholar 

  25. Saigal S, Doyle LW. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet. 2008;371(9608):261–9.

    CrossRef  PubMed  Google Scholar 

  26. Vrijlandt EJ, Boezen HM, Gerritsen J, Stremmelaar EF, Duiverman EJ. Respiratory health in prematurely born preschool children with and without bronchopulmonary dysplasia. J Pediatr. 2007;150(3):256–61.

    CAS  CrossRef  PubMed  Google Scholar 

  27. Vrijlandt EJ, Gerritsen J, Boezen HM, Duiverman EJ. Gender differences in respiratory symptoms in 19-year-old adults born preterm. Respir Res. 2005;6:117.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  28. Kugelman A, Colin AA. Late preterm infants: near term but still in a critical developmental time period. Pediatrics. 2013;132(4):741–51.

    CrossRef  PubMed  Google Scholar 

  29. Vrijlandt EJ, Kerstjens JM, Duiverman EJ, Bos AF, Reijneveld SA. Moderately preterm children have more respiratory problems during their first 5 years of life than children born full term. Am J Respir Crit Care Med. 2013;187(11):1234–40.

    CrossRef  PubMed  Google Scholar 

  30. Abe K, Shapiro-Mendoza CK, Hall LR, Satten GA. Late preterm birth and risk of developing asthma. J Pediatr. 2010;157(1):74–8.

    CrossRef  PubMed  Google Scholar 

  31. Voge GA, Katusic SK, Qin R, Juhn YJ. Risk of asthma in late preterm infants: a propensity score approach. J Allergy Clin Immunol Pract. 2015;3(6):905–10.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  32. Fawke J, Lum S, Kirkby J, Hennessy E, Marlow N, Rowell V, et al. Lung function and respiratory symptoms at 11 years in children born extremely preterm: the EPICure study. Am J Respir Crit Care Med. 2010;182(2):237–45.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  33. Wong PM, Lees AN, Louw J, Lee FY, French N, Gain K, et al. Emphysema in young adult survivors of moderate-to-severe bronchopulmonary dysplasia. Eur Respir J. 2008;32(1399–3003; 2):321–8.

    CAS  CrossRef  PubMed  Google Scholar 

  34. Narang I. Review series: What goes around, comes around: childhood influences on later lung health? Long-term follow-up of infants with lung disease of prematurity. Chron Respir Dis. 2010;7(4):259–69.

    CrossRef  PubMed  Google Scholar 

  35. Bader D, Ramos AD, Lew CD, Platzker AC, Stabile MW, Keens TG. Childhood sequelae of infant lung disease: exercise and pulmonary function abnormalities after bronchopulmonary dysplasia. J Pediatr. 1987;110(0022–3476; 5):693–9.

    CAS  CrossRef  PubMed  Google Scholar 

  36. Smith VC, Zupancic JA, McCormick MC, Croen LA, Greene J, Escobar GJ, et al. Trends in severe bronchopulmonary dysplasia rates between 1994 and 2002. J Pediatr. 2005;146(4):469–73.

    CrossRef  PubMed  Google Scholar 

  37. Fanta CH. Asthma. N Engl J Med. 2009;360(10):1002–14.

    CAS  CrossRef  PubMed  Google Scholar 

  38. Quanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH, et al. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J. 2012;40(6):1324–43.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  39. Kallapur SG, Ikegami M. Physiological consequences of intrauterine insults. Paediatr Respir Rev. 2006;7(2):110–6.

    CrossRef  PubMed  Google Scholar 

  40. Sonnenschein-van der Voort AM, Jaddoe VW, Raat H, Moll HA, Hofman A, de Jongste JC, et al. Fetal and infant growth and asthma symptoms in preschool children: the Generation R Study. Am J Respir Crit Care Med. 2012;185(7):731–7.

    CrossRef  PubMed  Google Scholar 

  41. Vollsaeter M, Roksund OD, Eide GE, Markestad T, Halvorsen T. Lung function after preterm birth: development from mid-childhood to adulthood. Thorax. 2013;68(8):767–76.

    CrossRef  PubMed  Google Scholar 

  42. Coalson JJ. Pathology of bronchopulmonary dysplasia. Semin Perinatol. 2006;30(0146–0005; 4):179–84.

    CrossRef  PubMed  Google Scholar 

  43. Narayanan M, Beardsmore CS, Owers-Bradley J, Dogaru CM, Mada M, Ball I, et al. Catch-up alveolarization in ex-preterm children: evidence from (3)He magnetic resonance. Am J Respir Crit Care Med. 2013;187(10):1104–9.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  44. Kotecha SJ, Edwards MO, Watkins WJ, Henderson AJ, Paranjothy S, Dunstan FD, et al. Effect of preterm birth on later FEV1: a systematic review and meta-analysis. Thorax. 2013;68(8):760–6.

    CrossRef  PubMed  Google Scholar 

  45. Baraldi E, Bonetto G, Zacchello F, Filippone M. Low exhaled nitric oxide in school-age children with bronchopulmonary dysplasia and airflow limitation. Am J Respir Crit Care Med. 2005;171(1):68–72.

    CrossRef  PubMed  Google Scholar 

  46. Carraro S, Piacentini G, Lusiani M, Uyan ZS, Filippone M, Schiavon M, et al. Exhaled air temperature in children with bronchopulmonary dysplasia. Pediatr Pulmonol. 2010;45(12):1240–5.

    CrossRef  PubMed  Google Scholar 

  47. Clouse BJ, Jadcherla SR, Slaughter JL. Systematic review of inhaled bronchodilator and corticosteroid therapies in infants with bronchopulmonary dysplasia: implications and future directions. PLoS One. 2016;11(2):e0148188.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  48. Kotecha SJ, Edwards MO, Watkins WJ, Lowe J, Henderson AJ, Kotecha S. Effect of bronchodilators on forced expiratory volume in 1 s in preterm-born participants aged 5 and over: a systematic review. Neonatology. 2015;107(3):231–40.

    CrossRef  PubMed  Google Scholar 

  49. Chan KN, Silverman M. Increased airway responsiveness in children of low birth weight at school age: effect of topical corticosteroids. Arch Dis Child. 1993;69(1468–2044; 1):120–4.

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

  50. Bolton CE, Bush A, Hurst JR, Kotecha S, McGarvey L. Republished: lung consequences in adults born prematurely. Postgrad Med J. 2015;91(1082):712–8.

    CrossRef  PubMed  Google Scholar 

  51. Blanken MO, Rovers MM, Molenaar JM, Winkler-Seinstra PL, Meijer A, Kimpen JL, et al. Respiratory syncytial virus and recurrent wheeze in healthy preterm infants. N Engl J Med. 2013;368(19):1791–9.

    CAS  CrossRef  PubMed  Google Scholar 

  52. Madurga A, Mizikova I, Ruiz-Camp J, Morty RE. Recent advances in late lung development and the pathogenesis of bronchopulmonary dysplasia. Am J Physiol Lung Cell Mol Physiol. 2013;305(12):L893–905.

    CAS  CrossRef  PubMed  Google Scholar 

  53. Colin AA, McEvoy C, Castile RG. Respiratory morbidity and lung function in preterm infants of 32 to 36 weeks’ gestational age. Pediatrics. 2010;126(1):115–28.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  54. Henschen M, Stocks J, Brookes I, Frey U. New aspects of airway mechanics in pre-term infants. Eur Respir J. 2006;27(5):913–20.

    CAS  PubMed  Google Scholar 

  55. Plopper CG, Nishio SJ, Schelegle ES. Tethering tracheobronchial airways within the lungs. Am J Respir Crit Care Med. 2003;167(1):2–3.

    CrossRef  PubMed  Google Scholar 

  56. Wong P, Murray C, Louw J, French N, Chambers D. Adult bronchopulmonary dysplasia: computed tomography pulmonary findings. J Med Imaging Radiat Oncol. 2011;55(4):373–8.

    CrossRef  PubMed  Google Scholar 

  57. Aquino SL, Schechter MS, Chiles C, Ablin DS, Chipps B, Webb WR. High-resolution inspiratory and expiratory CT in older children and adults with bronchopulmonary dysplasia. AJR Am J Roentgenol. 1999;173(4):963–7.

    CAS  CrossRef  PubMed  Google Scholar 

  58. Boyce TG, Mellen BG, Mitchel Jr EF, Wright PF, Griffin MR. Rates of hospitalization for respiratory syncytial virus infection among children in medicaid. J Pediatr. 2000;137(6):865–70.

    CAS  CrossRef  PubMed  Google Scholar 

  59. Gijtenbeek RG, Kerstjens JM, Reijneveld SA, Duiverman EJ, Bos AF, Vrijlandt EJ. RSV infection among children born moderately preterm in a community-based cohort. Eur J Pediatr. 2015;174(4):435–42.

    CrossRef  PubMed  Google Scholar 

  60. Simoes EA, Groothuis JR, Carbonell-Estrany X, Rieger CH, Mitchell I, Fredrick LM, et al. Palivizumab prophylaxis, respiratory syncytial virus, and subsequent recurrent wheezing. J Pediatr. 2007;151(1):34–42. 42.e1.

    CAS  CrossRef  PubMed  Google Scholar 

  61. Simoes EA, Carbonell-Estrany X, Rieger CH, Mitchell I, Fredrick L, Groothuis JR, et al. The effect of respiratory syncytial virus on subsequent recurrent wheezing in atopic and nonatopic children. J Allergy Clin Immunol. 2010;126(2):256–62.

    CrossRef  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Elianne Vrijlandt MD, PhD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Vrijlandt, E. (2017). Why Do Preterm Infants Wheeze? Clues from Epidemiology. In: Hibbs, A., Muhlebach , M. (eds) Respiratory Outcomes in Preterm Infants. Respiratory Medicine. Humana Press, Cham. https://doi.org/10.1007/978-3-319-48835-6_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-48835-6_2

  • Published:

  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-48834-9

  • Online ISBN: 978-3-319-48835-6

  • eBook Packages: MedicineMedicine (R0)