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.
Pulmonologists, critical care specialists, translational researchers, and clinicians
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
1.00 AMA PRA Category 1 Credit
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.
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