Summary for Clinicians: Clinical Practice Guidelines for Outpatient Respiratory Management of Infants, Children, and Adolescents with Post-Prematurity Respiratory Disease

Summary for Clinicians: Clinical Practice Guidelines for Outpatient Respiratory Management of Infants, Children, and Adolescents with Post-Prematurity Respiratory Disease




$25.00 USD

Provided by the American Thoracic Society
Release Date: October 04, 2022

Program Description

Pulmonary disease is a common sequela of premature birth. Bronchopulmonary dysplasia (BPD) (1), also known as chronic lung disease of prematurity, afflicts 12,000–15,000 infants in the United States per year (2–5) and 50% of infants with birth weights less than 1,000 g (6). Premature infants with respiratory disease have prolonged and recurrent hospitalizations (7) with a continued need for close clinical monitoring in outpatient settings.

In 2003, the American Thoracic Society published the “Statement on the Care of the Child with Chronic Lung Disease of Infancy and Childhood,” which has been a valuable clinical tool. Given significant advances in the care of extremely premature infants and subsequent changing physiology of chronic lung disease of infancy (8), there was a need for updated longitudinal recommendations for infants, children, and adolescents who were born premature and have chronic lung disease.

The American Thoracic Society convened a multidisciplinary panel of international specialists with expertise in post-prematurity respiratory disease (PPRD). “PPRD” is a more general term that describes all respiratory disease after preterm birth without adhering to one particular definition of BPD (7).

Represented disciplines included pediatric pulmonology, neonatology, otolaryngology, sleep medicine, radiology, nursing, and families of patients. Guideline development methodology was formed using the Grading of Recommendations, Assessment, Development, and Evaluation approach (9) to rate the strength of the recommendations (Table 1). The patient/intervention/comparator/outcome format was used to formulate management questions. The panel reviewed the best available evidence in the literature. After discussion and consensus, seven recommendations were made for the outpatient management of patients with PPRD. The guideline was published in the American Journal of Respiratory and Critical
Care Medicine in 2021 (10).

This document is a summary of the clinical practice guidelines, prepared for clinicians who manage infants, children, and adolescents with PPRD in the outpatient setting. The recommendations are organized into those involving medications (Table 2) and diagnostics (Table 3). Clinicians should tailor these recommendations to individual patients’ clinical needs.

Target Audience

Pulmonologists, critical care specialists, translational researchers, and clinicians

Learning Objectives

At the conclusion of this activity, learners should be able to:

  • Recognize when a trial of inhaled bronchodilators or inhaled corticosteroids is warranted in patients with post-prematurity respiratory disease (PPRD)
  • Identify patients with PPRD and additional comorbidities who may benefit from additional diagnostic tests
  • Evaluate central airway malacia in patients with PPRD and associated symptoms

Course summary

Available Credit:
1.00 Participation
1.00 AMA PRA Category 1 Credit

Credit Expires: May 31, 2024

Format: Journal


The American Thoracic Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Type Credit/Points Credit Designation Statement
AMA PRA Category 1 Credit™ 1.00 The American Thoracic Society designates this Journal for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


Article Authorship Disclosures (as submitted to the ATS prior to article publication date)

Laurie C. Eldredge, M.D., Ph.D. (University of Washington School of Medicine, Seattle, WA, USA) reported no relevant financial relationships.

Jonathan C. Levin, M.D. (Boston Children’s Hospital, Boston, MA, USA) reported no relevant financial relationships.

Michael C. Tracy, M.D. (Stanford University School of Medicine, Stanford, CA, USA) reported no relevant financial relationships.

Ioana A. Cristea, M.D. (Indiana University School of Medicine, Indianapolis, IA, USA) reported no relevant financial relationships.

Christopher D. Baker, M.D. (Children’s Hospital Colorado, Aurora, CO, USA) reported no relevant financial relationships.

Joseph K. Ruminjo, M.D. (American Thoracic Society, New York, NY, USA) reported no relevant financial relationships.

Carey C. Thomson, M.D., M.P.H. (Mt. Auburn Hospital, Cambridge, MA, USA) reported no relevant financial relationships.

Off-Label Usage Disclosure


Disclosures of AnnalsATS CME Planners

The Annals of the American Thoracic Society (AnnalsATS) original research, commentaries, reviews, and educational content of interest to clinicians and clinical investigators in pediatric and adult pulmonary and sleep medicine and medical critical care. The scope of the journal encompasses content that is applicable to clinical practice, the formative and continuing education of clinical specialists, and the advancement of public health.

The publication of articles that meet these goals by itself is only one step in a multi-step process for the translation of evidence-based improvements in are to clinical practice. Testing for CME credit is designed to function as a next step in the process. This is accomplished through a series of questions written by the author(s) to test that readers have the tools needed to translate recommendations for diagnostic and therapeutic clinical care into clinical practice. Members of the AnnalsATS editorial board review these questions and edit these questions for clarity, educational content, and the quality of the evidence.

AnnalsATS CME Planners
Alan M. Fein, M.D.
Podcast Editor, AnnalsATS
Dr. Fein reported that he has no financial relationships with commercial interests.

Constantine Manthous, M.D.
Associate Editor, AnnalsATS
Dr. Manthous reported that he has no financial relationships with commercial interests.

Gregory A. Schmidt, M.D.
Editorial Board, AnnalsATS
Dr. Schmidt reported payments for writing a textbook on critical care medicine (McGraw-Hill) and for writing contributions for UptoDate.


To receive credit for this journal article:

  1. Read the journal article. Keep track of how long it takes you to read it.
  2. Once you open the article, the Post-Test becomes available. After reading the article, answer the post-test questions. You must answer all questions correctly to earn credit. You may take the test as many times as you like.
  3. Once you pass the Post-Test, the Evaluation becomes available. Answer all the evaluation questions.
  4. Once you complete the evaluation, select the amount of credit to receive based on the time it took you to read the article.
  5. You can view, save and print your Certificate by pressing the Certificate button.
  6. To review the credits you've earned in this system and reprint certificates, go to the My Learning drop-down list. Then select Transcript.