Department of Paediatrics, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.
Department of Pediatrics, Division of Respiratory Medicine and Allergology, Sophia Children's Hospital - Erasmus MC, Rotterdam, The Netherlands.
Allergy. 2024 Nov;79(11):2924-2942. doi: 10.1111/all.16342. Epub 2024 Oct 9.
Moderate-late preterm-born infants experience more frequent and severe respiratory tract infections and wheezing compared to term-born infants. Decreasing the risk on respiratory tract infections and wheezing in this group is vital to improve quality of life and reduce medical consumption during infancy, but also to reduce the risk on asthma and COPD later in life. Until now, moderate-late preterm infants are underrepresented in research and mechanisms underlying their morbidity are largely unknown, although they represent 80% of all preterm-born infants. In order to protect these infants effectively, it is essential to understand the role of the immune system in early life respiratory health and to identify strategies to optimize immune development and respiratory health. This review elaborates on risk factors and preventative measures concerning respiratory tract infections and wheezing in preterm-born infants, exploring their impact on the immune system and microbiome. Factors discussed are early life antibiotic use, birth mode, feeding type and living environment. Further, differences in adaptive and innate immune maturation between term and preterm infants are discussed, as well as differences in local immune reactions in the lungs. Finally, preventative strategies are being explored, including microbiota transplantation, immune modulation (through pre-, pro-, syn- and postbiotics, bacterial lysates, vaccinations, and monoclonal antibodies) and antibiotic prophylaxis.
中度至晚期早产儿比足月出生的婴儿更容易频繁且严重地患上呼吸道感染和喘息。降低该群体呼吸道感染和喘息的风险对于提高生活质量和减少婴儿期的医疗消耗至关重要，也可以降低他们日后患哮喘和 COPD 的风险。到目前为止，中度至晚期早产儿在研究中代表性不足，其发病机制在很大程度上尚不清楚，尽管他们占所有早产儿的 80%。为了有效地保护这些婴儿，了解免疫系统在生命早期的呼吸道健康中的作用以及确定优化免疫发育和呼吸道健康的策略至关重要。这篇综述详细阐述了早产儿呼吸道感染和喘息的危险因素和预防措施，探讨了它们对免疫系统和微生物组的影响。讨论的因素包括早期生活中的抗生素使用、分娩方式、喂养类型和生活环境。此外，还讨论了足月和早产儿之间适应性和先天免疫成熟的差异，以及肺部局部免疫反应的差异。最后，还探讨了预防策略，包括微生物组移植、免疫调节（通过前、原、共生和后生、细菌裂解物、疫苗和单克隆抗体）和抗生素预防。
