Respiratory specialists working in silos when “virtually all chest diseases have their origins in childhood”

A more cohesive strategy spanning obstetrics, neonatology, paediatrics and adult practice is needed to improve outcomes for adults with lung health issues stemming from having been born prematurely, experts have suggested.

In an editorial published in Thorax, Professors Warren Lenney, a retired Professor of Respiratory Child Health and Neil Harlow, a Professor of Neonatal Medicine, highlighted a growing tendency for healthcare professionals to work in silos despite growing evidence that most diseases “span the course of life”.

In particular, there should be greater interest in the outcomes of prematurely born babies as mounting evidence indicated that “virtually all chest diseases have their origins in childhood,” they noted.

As such, it was essential to recognise those who are at risk of respiratory disease at the earliest opportunity so that “comprehensive respiratory follow-up” can be ensured in childhood and through adult life.

“Neonatologists need to reconnect with paediatric respiratory specialists to identify this important group for adult respiratory services to take on board through joint transition clinics, as has been happening in patients with cystic fibrosis for many years. The process commences by simply taking a perinatal history,” they wrote.

“Those at risk deserve better attention and an approved and funded preventative health programme. This should include research studies to minimise further lung damage to prevent progression and complement the extensive perinatal/neonatal work on prevention of early lung injury.”

Their comments follow new findings from a study based in Norway, also published in Thorax, which showed that premature birth can have a lasting impact on lung growth and development.

The research team followed Norwegian babies with extreme prematurity (EP; born before 28 weeks of gestation or with <1000 g birth weight) for up to 35 years of age, tracking their lung function at 0, 18 and 25 years of age.

After normalising scores for sex, age and height, they found that the preterm-born group, particularly those with neonatal bronchopulmonary dysplasia (BPD), exhibited significantly lower forced expiratory volume in 1s and mid-expiratory flow than those born at term across all assessment points.

“Airway obstruction was observed throughout the complete study period and was most pronounced for those with neonatal BPD,” the authors noted.

However, they also observed that lung function trajectories did not differ between the preterm- and term-born groups or between those born preterm with and without neonatal BPD, “suggesting a parallel development throughout the study period”.

Also, as Professor Lenney and Harlow noted, a key finding of concern was that one in three EP participants met the postbronchodilator spirometry criteria for COPD diagnosis, though “this was not necessarily in those diagnosed with BPD in the newborn period”.

The study authors concluded that while age-related decline in lung function varies between subjects, with factors such as cigarette smoking, childhood pneumonias and airway hyperresponsiveness potentially accelerating the process, their findings “underline the risk of premature onset of COPD” in preterm-born individuals.

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