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Longer Term Sequelae of Prematurity: The Adolescent and Young Adult

  • Andrew BushEmail author
  • Charlotte E. Bolton
Chapter
Part of the Respiratory Medicine book series (RM)

Abstract

Preterm delivery is becoming increasingly common, and with changes in neonatal intensive care, even small and more immature babies are surviving into adult life. These treatment changes are reflected also in the different patterns of disease in survivors, previously largely affecting the airway, but currently more leading to alveolar hypoplasia. Furthermore, long-term consequences are not restricted to very preterm babies, but are seen even in those born at 37–38 weeks gestation, requiring no neonatal intervention at all. Sequelae in adults include increased morbidity and even mortality, airflow obstruction, alveolar hypoplasia, focal structural changes, and impairment of exercise performance. The airway disease is characterized by fixed and variable airflow obstruction, but without evidence of type 2 inflammation, despite which prescription of inhaled corticosteroids is common. Despite the number and frequency of physiological deficits, most survivors who do not have comorbidities are living unrestricted lives. However, many survivors with neurodevelopmental and other handicaps often fail to obtain the holistic care they need. The very long-term consequences of prematurity, specifically whether they will develop premature airflow obstruction, are largely speculative, nor is it known if the pathophysiology of late airways disease will be the same as that in heavy smokers.

Keywords

Bronchopulmonary dysplasia Airflow obstruction Alveolar hypoplasia Exercise Control of breathing Airway inflammation Bronchial hyperresponsiveness 

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.PaediatricsImperial CollegeLondonUK
  2. 2.Paediatric RespirologyNational Heart and Lung Institute, Royal Brompton Harefield NHS Foundation TrustLondonUK
  3. 3.Department of Paediatric Respiratory MedicineRoyal Brompton HospitalLondonUK
  4. 4.Respiratory MedicineUniversity of Nottingham, Clinical SciencesNottinghamUK
  5. 5.Nottingham University Hospitals Trust, Clinical SciencesNottinghamUK

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