Pulmonary and neurological follow-up of extremely preterm infants

The long-term consequences of extreme prematurity assume more importance as survival rates increase. Pulmonary problems are common immediately after birth and most extremely preterm (EP) infants (<28 weeks' gestation) require respiratory support. Many survivors develop bronchopulmonary dysplasia and some have long-term oxygen dependency, occasionally for years. Their brain has to respond to an environment very different to that of the uterus, and cerebroventricular haemorrhage and white matter injury occur much more frequently than in term infants. Compared with children born at term, EP survivors have higher rates of wheezing and hospital readmission for respiratory illnesses in the first few years after the primary hospitalisation. As they grow older they have reduced pulmonary function, particularly airway obstruction, and lower exercise tolerance. Larger proportions of EP children have significant developmental and motor delay in early childhood. At school age other cognitive impairments including learning disabilities and behavioural problems occur more frequently. Despite these difficulties, most EP survivors escape without major long-term pulmonary or neurological problems.