Influences of environmental exposures on preterm lung disease

ABSTRACT

Introduction: Environmental factors play a critical role in the progression or resolution of chronic respiratory diseases. However, studies are limited on the impact of environmental risk factors on individuals born prematurely with lung disease after they leave the neonatal intensive care unit and are discharged into the home environment.

Areas covered: In this review, we cover current knowledge of environmental exposures that impact outcomes of preterm respiratory disease, including air pollution, infections, and disparities. The limited data do suggest that certain exposures should be avoided and there are potential preventative strategies for other exposures. There is a need for additional research outside the neonatal intensive care unit that focuses on individual and community-level factors that affect long-term outcomes.

Expert opinion: Preterm respiratory disease can impose a significant burden on infants, children, and young adults born prematurely, but may improve for many individuals over time. In this review, we outline the exposures that may potentially hasten, delay, or prevent resolution of lung injury in preterm children.

KEYWORDS:

• Bronchopulmonary dysplasia
• environment
• outpatient
• smoke
• electronic cigarette
• air pollution
• daycare
• disparities
• race/ethnicity
• chronic lung disease

Article highlights

• Individuals who are born prematurely have a high burden of respiratory disease, which is not necessarily limited to the archetype of bronchopulmonary dysplasia.

• Although respiratory manifestations associated with premature birth generally improve with time, some can persist into adulthood.

• Although children born prematurely may have a quiescent period of symptomatology, they are at higher risk for early onset COPD; avoidance of adverse environmental exposures may mitigate this risk.

• A number of environmental factors can delay resolution, but evidence is limited. In this review, we outline factors, including air pollution, socioeconomic factors, infection risks, etc., along with strategies to mitigate them.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Conflicts of interest

There are no conflicts of interest.

Reviewer disclosures

Peer reviewers in this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by the National Institutes of Health (Bethesda, MD, USA) (JLR: K23 ES029985; SAM: R01 HL114800). The funding sources had no involvement in the writing of the manuscript or the decision to submit it.