Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ann Am Thorac Soc. 2018 May;15(5):530-538. doi: 10.1513/AnnalsATS.201709-756FR.
Ongoing advancements in neonatal care since the late 1980s have led to increased numbers of premature infants surviving well beyond the neonatal period. As a result of increased survival, many individuals born preterm manifest chronic respiratory symptoms throughout infancy, childhood, and adult life. The archetypical respiratory disease of prematurity, bronchopulmonary dysplasia, is the second most common chronic pediatric respiratory disease after asthma. However, there are several commonly held misconceptions. These misconceptions include that bronchopulmonary dysplasia is rare, that bronchopulmonary dysplasia resolves within the first few years of life, and that bronchopulmonary dysplasia does not impact respiratory health in adult life. This focused review describes a spectrum of respiratory conditions that individuals born prematurely may experience throughout their lifespan. Specifically, this review provides quantitative estimates of the number of individuals with alveolar, airway, and vascular phenotypes associated with bronchopulmonary dysplasia, as well as non-bronchopulmonary dysplasia respiratory phenotypes such as airway malacia, obstructive sleep apnea, and control of breathing issues. Furthermore, this review illustrates what is known about the potential for progression and/or lack of resolution of these respiratory phenotypes in childhood and adult life. Recognizing the spectrum of respiratory phenotypes associated with individuals born preterm and providing comprehensive and personalized care to these individuals may help to modulate adverse respiratory outcomes in later life.
自 20 世纪 80 年代末以来，新生儿护理的不断进步导致早产儿的存活率大大提高，远远超过了新生儿期。由于存活率的提高，许多早产儿在婴儿期、儿童期和成年期都会出现慢性呼吸系统症状。作为早产儿典型的呼吸系统疾病，支气管肺发育不良是继哮喘之后第二常见的慢性儿科呼吸系统疾病。然而，存在一些普遍存在的误解。这些误解包括：支气管肺发育不良很少见，支气管肺发育不良会在生命的头几年内得到解决，以及支气管肺发育不良不会影响成年后的呼吸健康。本专题综述描述了早产儿在其整个生命周期中可能经历的一系列呼吸系统疾病。具体而言，本综述提供了与支气管肺发育不良相关的肺泡、气道和血管表型以及非支气管肺发育不良呼吸表型（如气道软化、阻塞性睡眠呼吸暂停和呼吸控制问题）的个体数量的定量估计。此外，本综述说明了人们对这些呼吸表型在儿童和成年期的进展和/或无法解决的可能性的了解。认识到与早产儿相关的呼吸表型谱，并为这些个体提供全面和个性化的护理，可能有助于调节晚年的不良呼吸结局。
