Does neonatal sepsis affect the lung function of children and adults born prematurely?

Prematurity is increasing worldwide but, despite improvements in neonatal care, there has been little change in the subsequent respiratory morbidity of those born prematurely. 1 , 2 Both antenatal corticosteroids and postnatal surfactant have resulted in reductions in mortality and respiratory distress, yet had no impact on bronchopulmonary dysplasia (BPD), nor were associated with improvements in airway function at follow-up. 3 Extremely prematurely born children born before or after the introduction of antenatal corticosteroids and postnatal surfactant had similarly impaired lung function, with forced expiratory volume in one second (FEV 1 ) and maximum mid expiratory flow (MMEF) values more than one standard deviation below the norm in both cohorts. 3 Many other studies have also demonstrated those born prematurely have worse lung function even into adolescence and adulthood. 4 This impaired lung function results in functional limitations as demonstrated by those with the worst lung function have significantly poorer exercise tolerance. 5 Amongst 126 extremely prematurely born individuals studied at a mean age of 17 years those with a very abnormal lung function (forced expiratory flow at 75% of exhaled vital capacity (FEF75) below the 2.5 th per centile) had a reduction in a sprint shuttle test result of 159 metres. 5 To put that result in context, adults who had a positive response to a cardiac rehabilitation programme had an increase in a shuttle test result of 70 metres, highlighting the substantial functional deficit that can occur in extremely prematurely born individuals with the worst lung function.