Merino-Hernández Amaia, Ramos-Navarro Cristina, Muñoz-Cutillas Agustin, Bellón-Alonso Sara, Rodríguez-Cimadevilla Juan Luis, González-Pacheco Noelia, Sánchez-Luna Manuel
Department of Neonatology, Gregorio Marañón University Hospital, O'Donnell 48 street, 28009, Madrid, Spain.
Department of Pediatric Pulmonology, Gregorio Marañón University Hospital, O'Donnell 48 Street, 28009, Madrid, Spain.
Eur J Pediatr. 2025 May 30;184(6):375. doi: 10.1007/s00431-025-06193-7.
Preterm infants with bronchopulmonary dysplasia (BPD) are at increased risk of respiratory morbidity in the early years of life, including higher rates of persistent wheezing, asthma, and hospital admissions. The objective was to assess respiratory symptoms at school age in a cohort of very and extremely preterm infants with and without BPD. We conducted a prospective observational study of infants born before 32 weeks of gestation who were admitted to our neonatal unit between January 2012 and December 2014. Diagnosis and grade of BPD were defined according to the NIH consensus. Follow-up was performed after hospital discharge, and respiratory symptoms were assessed between 7 and 10 years of age using the Global Asthma Network (GAN) questionnaire. Of the 327 patients born during the study period, 94 completed the GAN questionnaire (mean age 8.6 years, SD 0.8). Overall, 51% reported wheezing, which was more common in the BPD 2-3 group (75%) than in the no BPD/1 group (47%) (p = 0.03), a difference that remained significant after adjustment for gestational age (OR 3.15, 95% CI 1.01 - 10.01). Asthma symptoms were also more common in the BPD 2-3 group (40%) compared to the no BPD/1 group (12%) (p < 0.01). Respiratory hospitalizations in the first 2 years of life were significantly higher in the BPD 2-3 group (61% vs. 25%, p = 0.01), with a fourfold increased risk after adjustment for gestational age (OR 4.7, 95% CI 1.5 - 14.6). No significant differences in wheezing were found between patients without BPD and those with grade 1 BPD (55% vs. 22%, p = 0.07), or between those born before and after 28 weeks' gestation (59% vs. 51%, p = 0.52).
In our population of preterm school-aged children, those with grade 2 or 3 BPD had significantly higher rates of wheezing, asthma symptoms, and hospital admissions in the first two years of life than those without BPD or with grade 1 BPD. There were no significant differences in respiratory symptoms between patients with no BPD and those with grade 1 BPD, nor between those born before or after 28 weeks' gestation.
• Preterm infants with BPD are at higher risk of developing respiratory problems such as wheezing and asthma during childhood. Most existing data come from older cohorts, and recent improvements in neonatal care may have modified long-term respiratory outcomes.
• In this recent cohort of very and extremely preterm infants, those with grade 2 or 3 BPD showed significantly higher rates of wheezing, asthma symptoms, and early hospitalizations. No differences were observed between children with no BPD and those with grade 1 BPD, nor between those born before or after 28 weeks' gestation. These findings highlight the impact of BPD severity on long-term respiratory morbidity.
支气管肺发育不良（BPD）的早产儿在生命早期发生呼吸系统疾病的风险增加，包括持续性喘息、哮喘和住院率升高。目的是评估一组患有和未患有BPD的极早早产儿和超低出生体重儿在学龄期的呼吸道症状。我们对2012年1月至2014年12月期间入住我们新生儿病房、孕周小于32周的婴儿进行了一项前瞻性观察研究。BPD的诊断和分级根据美国国立卫生研究院（NIH）的共识确定。出院后进行随访，并使用全球哮喘网络（GAN）问卷在7至10岁时评估呼吸道症状。在研究期间出生的327例患者中，94例完成了GAN问卷（平均年龄8.6岁，标准差0.8）。总体而言，51%的患者报告有喘息，这在BPD 2 - 3组（75%）中比在无BPD/1组（47%）中更常见（p = 0.03），在调整孕周后该差异仍然显著（比值比3.15，95%置信区间1.01 - 10.01）。哮喘症状在BPD 2 - 3组（40%）中也比无BPD/1组（12%）更常见（p < 0.01）。BPD 2 - 3组在生命的前2年因呼吸道疾病住院的比例显著高于无BPD/1组（61%对25%，p = 0.01），在调整孕周后风险增加了四倍（比值比4.7，95%置信区间1.5 - 14.6）。在无BPD的患者和患有1级BPD的患者之间（55%对22%，p = 0.07），以及在孕周28周之前和之后出生的患者之间（59%对51%，p = 0.52），喘息发生率没有显著差异。
在我们的早产学龄儿童群体中，患有2级或3级BPD的儿童在生命的前两年出现喘息、哮喘症状和住院的发生率显著高于无BPD或患有1级BPD的儿童。无BPD的患者和患有1级BPD的患者之间，以及孕周28周之前和之后出生的患者之间，呼吸道症状没有显著差异。
• 患有BPD的早产儿在儿童期发生喘息和哮喘等呼吸道问题的风险更高。大多数现有数据来自较老的队列，新生儿护理的近期改善可能改变了长期呼吸道结局。
• 在这个近期的极早早产儿和超低出生体重儿队列中，患有2级或3级BPD的儿童喘息、哮喘症状和早期住院的发生率显著更高。在无BPD的儿童和患有1级BPD的儿童之间，以及在孕周28周之前和之后出生的儿童之间没有观察到差异。这些发现突出了BPD严重程度对长期呼吸道疾病的影响。
