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125 Copd in the Next 50 Years-Should we Blame the Neonatologists?
  1. EJLE Vrijlandt
  1. Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands

Abstract

In this talk, the current knowledge of respiratory sequelae following preterm birth in adulthood will be summarized. Specifically it will review respiratory symptoms, pulmonary function, exercise capacity and structural lung disease as determined by high resolution computed tomography.

How much of the problems of ex-preterms are due to natural causes, how much to iatrogenic causes? Of these two items, it is the natural influences that are studied most. A large number of cohort studies showed several themes that may have impact on lung development: antenatal factors such as the effects of smoking on airway anatomy and the fetal immune system, gene-environment interactions and post natal exposures. In this talk however, the focus will be on an area of growing interest- the iatrogenic long term influences on lung health. I mention here the follow up of neonatal intensive care but others exist such as the long term effects of lung transplantation.

During the talk data will be demonstrated showing that

  • ex-preterms do have more respiratory symptoms, also later in life and that the preterms with the lowest mean birth weight do have the most symptoms.

  • a significantly greater proportion of children with BPD compared with those preterm children without BPD had a clinically important reduction in their mean percentage predicted FEV1

  • Exercise capacity is not completely normal, but the differences are more subtle than expected.

  • Ct scans show linear and triangular opacities, gas trapping and mosaic perfusion, emphysema especially in severe BPD, which represent subjects with old and new BPD.

Perhaps the most important question for clinicians in the audience is “can we do anything to prevent long term sequelae and if not what should I do to explore the long term sequelae in the most efficient way?” At the end of the talk, it will be clear that preventive possibilities are scarce. However in order to improve long-term respiratory outcome and health-related quality of life of all preterm infants, efforts should be aimed at

  • preventing harmful viral lower respiratory infections during the first year of life

  • Reducing cigarette smoke exposure

  • Parental education that may increase awareness of disease

The EFCNI White Paper on Maternal and Newborn Health and Aftercare Services states that a worldwide network of long-term follow-up research into preterm children is needed. Long-term follow-up research into societal participation of adolescents born preterm should take place. The results can be used to develop interventions for teenagers born preterm to support them in their course of life towards adulthood; for example, by assigning job or life coaches. Research of long-term medical and social treatment of preterm children is needed and also guidelines for treatment and counseling by neonatologists, paediatricians, general physicians, well baby clinics and teachers should be developed.

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