Looking beyond bronchopulmonary dysplasia: prematurity-associated lung disease and its phenotypes. 2025

Christopher William Course, and Andrew Bush, and Sailesh Kotecha
Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK.

Preterm birth is increasingly recognised as a determinant of chronic respiratory disease across the life course. In this Series on prematurity-associated lung disease (PLD), we introduce the concept of PLD as a unifying framework for the diverse pulmonary consequences of preterm birth. Historically, most attention has focused on extremely preterm infants (<28 weeks of gestation) who develop bronchopulmonary dysplasia (BPD), yet not all infants with BPD have long-term morbidity. Conversely, those born very (28-31 weeks), moderate (32-33 weeks), or late (34-36 weeks) preterm also have increased risk for developing lung disease. Multiple factors beyond BPD-including gestational age and intrauterine growth restriction-contribute to PLD development. Recently described PLD phenotypes include prematurity-associated obstructive lung disease, prematurity-associated preserved ratio impaired spirometry, and prematurity-associated dysanapsis. Each phenotype reflects distinct early-life exposures and mechanisms, with differing implications for prognosis. Defining these phenotypes provides a foundation for personalised monitoring and targeted therapeutic strategies.

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