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Longer Term Sequelae of Prematurity: The Adolescent and Young Adult

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

AB was supported by the NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London.

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Correspondence to Andrew Bush MD, FRCP, FRCPCH, FERS .

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Bush, A., Bolton, C.E. (2017). Longer Term Sequelae of Prematurity: The Adolescent and Young Adult. 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_7

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