Long-Term Consequences of Brochopulmonary Dysplasia: Lung and Cardiac Function

Introduction Preterm birth represents a growing problem across the world. In recent years, treatment strategies for preterm newborns have improved significantly, resulting in an increase in the survival rate of such babies. Nevertheless, bronchopulmonary dysplasia (BPD) remains one of the most prevalent diseases of prematurity. The vast majority of studies on this topic—comparing preterm babies with BPD with babies born at term—where the differences are evident and do not compare neonates with and without BPD; all of them born preterm. Improving the knowledge of the medium- and long-term development of preterm patients with BPD is important for the planning of preventive strategies and for the minimization of the long-term consequences of such babies.

Materials and Methods An observational cross-sectional study was performed including babies born below 32 weeks’ gestational age with and without BPD born in 2003 and 2004 in the Hospital Severo Ochoa (Leganés, Spain) and the Hospital Clínico San Carlos (Madrid, Spain).

Key information was collected, including perinatal records from the patients’ medical history, data on respiratory symptoms and International Study of Asthma and Allergies of Childhood questionnaires, blood pressure measurements, exhaled nitric oxide measurements, skin tests for sensitization to neumoallergens, basal spirometry with bronchodilator tests, and echocardiograms.

Results The study included a total number of 74 patients, 21 had been diagnosed with BPD (12 mild, 8 moderate, and 1 severe).

There was no difference in the age at the moment of evaluation between the groups (14 years old).

No differences were found between the very premature patients who suffered from BPD and those who did not in diastolic nor systolic blood pressure.

No difference in admissions to hospital due to respiratory problems throughout childhood was found between the groups. Nevertheless, the BPD group required more admissions in a pediatric intensive care unit (28.5%) than the non-BPD group (5.6%) (p = 0.01; odds ratio [OR]: 5.05; 95% confidence interval [CI]: 1.4–18.3).

Patients with BPD had more wheezing episodes during childhood (85.7%) than no BDP group (62.3%) (p = 0.04, OR: 3.3, 95% CI: 1.03–10.8).

In patients with moderate-severe BPD, the current risk of asthma (wheezing in the last 12 months) was four times greater (55.6%) than that of very preterm (VP) individuals without BPD (16.9%) (p = 0.02, OR: 4.3, 95% CI: 2.1–8.9).

No significant differences were found in the pulmonary function of VP individuals with and without BPD groups.

When assessing right ventricle in VP individuals with moderate-severe BPD to those who did not develop it, the first group showed worse E/E’ relationship interquartile range (interquartile range [IQR]: 2.2–3.9 vs. IQR: 1.4–3.3, p = 0.03), and worst global function (myocardial performance index in the BPD group IQR: 0.08–0.39 vs. no BPD group IQR: 0.08–0.33, p = 0.02). When assessing left ventricle in individuals who developed moderate-severe BPD, the showed less shortening fraction (37.5 ± 3.20 vs. 40.7 ± 4.95%, p = 0.07), less ejection fraction (68 ± 4.38 vs. 71.23 ± 5.37%, p = 0.06) and a greater E/E’ ratio (6.4 ± 0.8 vs. 4.9 ± 1.04, p = 0.01).

Conclusion In adolescence, preterm infants with BPD develop changes in their respiratory and cardiovascular functions that could constitute the basis of diseases in adulthood. They show more severe respiratory complications needing more admissions in pediatric intensive care unit. No changes were found in their respiratory function. They also show worse systolic and diastolic left ventricle function. The long-term monitoring of preterm patients enables the detection of small changes caused by preterm birth; the avoidance of risk factors and the promotion of healthy habits that minimize the consequences of premature birth in adulthood.

Conflict of Interest

None declared.