Follow-up of neonatal chronic respiratory disease - an update based on the current evidence

Sep 30, 2026

Uploaded by Aria

Chronic respiratory morbidity after premature birth leads to persistent, multi-system complications involving airway function, lung parenchyma and cardiac morphology. This narrative review updates the current evidence on cardiorespiratory follow-up for extremely preterm infants, especially those with bronchopulmonary dysplasia. Evidence shows marked variation in follow-up frequency, components and duration, with limited support for specific recommendations. Common practice stops at 2 years, while later studies often rely mainly on spirometric indices and respiratory trajectories.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Conclusion

What is Known and What is New

Keywords

Introduction

Methods

Search strategy

Guidelines, frameworks and consensus statements

European Journal of Pediatrics (2026) 185:61 [https://doi.org/10.1007/s00431-025-06713-5](https://doi.org/10.1007/s00431-025-06713-5) |
REVIEW | | | | --- | --- | --- | | | | | | Follow-up of neonatal chronic respiratory disease: an update based on the current evidence
Allan Jenkinson1 · Theodore Dassios1,2,3
Received: 18 November 2025 / Revised: 10 December 2025 / Accepted: 20 December 2025 / Published online: 7 January 2026 © The Author(s) 2026
Abstract
Chronic respiratory morbidity following premature birth is associated with significant and long-standing complications affecting airway function, the lung parenchyma and cardiac morphology. The aim of this narrative review was to provide an update on the current evidence for the cardiorespiratory follow-up of extremely preterm infants, particularly those with bronchopulmonary dysplasia. There is currently wide variation in the frequency, components and duration in the follow-up of these infants and an absence of robust evidence to support specific recommendations. Follow-up is most commonly offered up to 2 years of age, and studies beyond this age primarily report spirometric indices to quantify lung function impairment and abnormal respiratory trajectories. Recent evidence has highlighted distinct phenotypes and the complex multisystem nature of respiratory disease following preterm birth, which includes patterns of persistent pulmonary vascular disease, abnormal parenchymal function and impaired cardiorespiratory fitness.
Conclusion: We suggest that follow-up of these infants should extend in time to early adulthood and focus on capturing and describing not only lung function test abnormalities but also include pulmonary vascular disease, parenchymal disease and cardiorespiratory exercise testing with a view to identify individuals who would benefit most from targeted interventions based on the dominant pathophysiological process at an individual level. | | | | What is Known:
• Preterm birth is associated with significant respiratory morbidity lasting into childhood, adolescence, and adulthood.
• There is a lack of sufficient high-level evidence to inform how these infants should be followed up in childhood and beyond.
What is New:
• Other than lung function abnormalities, preterm-born children and adults have parenchymal lung damage, pulmonary vascular disease and exercise limitation.
• Follow-up of individuals with significant neonatal respiratory disease should expand beyond early childhood and include more extensive cardiorespiratory assessments. | | | Keywords Bronchopulmonary dysplasia · Lung function · Pulmonary hypertension · Childhood · Exercise limitation Communicated by Daniele De Luca * Theodore Dassios [theodore.dassios@kcl.ac.uk](theodore.dassios@kcl.ac.uk) 1 Department of Women and Children’s Health, School of Life Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK 2 Neonatal Intensive Care Unit, University of Patras, Patras, Greece 3 Neonatal Intesive Care Centre, Golden Jubilee Wing, King’s College Hospital, Denmark Hill, London SE5 9RS, UK Introduction Advances in obstetric and neonatal care have resulted in increased incidence of preterm birth [1] . Furthermore, with the decrease of the border of viability to 22 weeks of gestation, the burden of prematurity is expected to continue to increase [2] . Despite recent advances, the incidence of chronic respiratory disease following premature birth, broadly captured by the term bronchopulmonary dysplasia (BPD), continues to rise [3]. The lifelong cardiorespiratory trajectories after preterm birth remain understudied [4, 5] . The first large groups of studied survivors have only recently reached adulthood with emerging evidence of early chronic obstructive pulmonary disease (COPD) and persistent pulmonary hypertension [6, 7] . Despite these lifelong adverse outcomes, clinical follow-up of this population is often limit

FAQs

Why is cardiorespiratory follow-up important after extremely preterm birth?

Chronic respiratory morbidity can cause long-standing complications across the airway, lung tissue, and cardiac structure, affecting cardiorespiratory trajectories over time.

What does the review suggest about how follow-up should be extended?

Follow-up should extend into early adulthood and should assess not only lung function abnormalities but also pulmonary vascular disease, parenchymal disease, and cardiorespiratory exercise testing to identify individuals likely to benefit from targeted interventions.

How do current practices typically differ in duration and measurements?

Follow-up is often offered up to 2 years of age, while studies beyond that point mainly report spirometric indices and respiratory trajectory measures, with wide variation across follow-up programmes and limited robust evidence for specific recommendations.

Sep 30, 2026

Uploaded by Aria