CHEST Guidelines-Optimizing-Lung-Function-in-Survivors-of-Preterm-B

Optimizing-Lung-Function-in-Survivors-of-Preterm-B

Pdf Summary

The article discusses the challenges of optimizing lung function in survivors of preterm birth, particularly focusing on the role of palivizumab, which is a monoclonal antibody used to protect against respiratory syncytial virus (RSV) infection. Despite its use in reducing hospitalizations in high-risk infants, recent studies, such as the one by Amitai et al., highlight that palivizumab does not offer long-term protection or improve lung function in adolescents born extremely preterm. <br /><br />Preterm birth, affecting between 8.7% to 13.4% of infants globally, interrupts the development of the respiratory system and can lead to chronic lung conditions like bronchopulmonary dysplasia (BPD). Follow-up studies in adults who were born preterm have demonstrated persistent airflow obstruction and emphysematous changes, with extremely premature infants showing a significant reduction in lung function, as measured by FEV1, and an elevation in lung clearance index (LCI), especially in those with BPD.<br /><br />In Amitai et al.'s research, the lack of discernable lung function improvement after palivizumab prophylaxis was noted, though the condition of bronchial hyperresponsiveness (BHR) improved by adolescence. The structural abnormalities related to prematurity—highlighted by ventilation heterogeneity and small airways dysfunction—persist, but do not appear to be associated with fibrotic changes.<br /><br />The article also underscores limitations in current research, such as the exclusion of cases with severe comorbidities, lack of data on corticosteroid treatment effects, and sample size considerations. Despite these limitations, the study provides critical insights for healthcare providers to better understand the long-term implications of preterm birth and the limited role of palivizumab in altering the lung function trajectories of affected individuals. This comprehensive data could help in strategizing care and interventions for preventing chronic lung diseases and potentially COPD in adults born preterm.

Keywords

preterm birth

lung function

palivizumab

RSV infection

bronchopulmonary dysplasia

airflow obstruction

FEV1

lung clearance index

bronchial hyperresponsiveness

chronic lung conditions