Long term respiratory outcomes in preterm infants with (or without) bronchopulmonary dysplasia: what is essential to know to improve their quality of life

In the last decades, advances in neonatal care have improved the survival of preterm infants, but these newborns remain more susceptible to a wide range of short and long term complications. Bronchopulmonary dysplasia (BPD)- or chronic lung disease-, is the most frequent morbidity among surviving preterm infants and is associated with long term pulmonary and neurodevelopmental impairments. In this narrative review, we aimed to synthesize the existing literature on long term respiratory outcomes of preterm infants, from discharge to adult life, with or without BPD. Preterm infants and/or those diagnosed with BPD have an increased risk of respiratory infections in the first two years of life and are also more likely to require hospitalization. Preterm infants also have an elevated risk of SIDS; nevertheless, this risk seems to be related to prematurity itself rather than the presence of BPD. In the long term, it has been observed that these children more commonly experience sleep disturbances, reduced physical exercise capacity, wheezing, asthma, as well as changes in some echocardiographic parameters and respiratory function tests. In summary, premature patients, particularly those survivors of moderate-severe BPD, present a series of chronic pulmonary and extrapulmonary comorbidities that make their management complex, even in the phases following discharge from the neonatal intensive care unit and in preadolescence. Children, adolescents, and adults with this condition require comprehensive, multidisciplinary management and close follow up to address the burden of comorbidities associated with prematurity and chronic lung disease. Randomized therapeutic studies, in addition to longitudinal evaluation, remain essential to optimize care.