Perinatal factors in neonatal and pediatric lung diseases

Abstract

Wheezing and asthma are significant clinical problems for infants and young children, particularly following premature birth. Recurrent wheezing in infants can progress to persistent asthma. As in adults, altered airway structure (remodeling) and function (increased bronchoconstriction) are also important in neonatal and pediatric airway diseases. Accumulating evidence suggests that airway disease in children is influenced by perinatal factors including perturbations in normal fetal lung development, postnatal interventions in the intensive care unit (ICU) and environmental and other insults in the neonatal period. Here, in addition to genetics, maternal health, environmental processes, innate immunity and impaired lung development/function can all influence pathogenesis of airway disease in children. We summarize current understanding of how prenatal and postnatal factors can contribute to development of airway diseases in neonates and children. Understanding these mechanisms will help identify and develop novel therapies for childhood airway diseases.

Keywords::

• asthma
• bronchoconstriction
• child
• infant
• perinatal
• remodeling
• wheezing

Financial & competing interests disclosure

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.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Development of lung disease in children and even in adults is influenced by both prenatal and postnatal factors.

• • Prenatal factors such as infection and chorioamnionitis and maternal factors including smoking, obesity and diabetes can substantially impair normal fetal lung development. The mechanisms underlying changes to lung structure and function induced by these factors are under investigation, and should lead to novel therapies for limiting their detrimental effects.

• • Postnatal factors that contribute to short-term and long-term pulmonary morbidity include treatments and procedures in the neonatal intensive care unit necessitated by premature birth or perinatal respiratory problems. In this regard, maternal health, environmental processes, immune responses of the child and impaired lung development and function can all influence the pathogenesis of lung disease in children. Understanding of the targets and effects of such factors on development of recurrent wheeze and asthma will help identify and develop novel therapies for children with airway diseases.

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