New recommendations are available to help guide physicians who must determine when and how to treat infants, children and adolescents with post-prematurity respiratory disease (PPRD). The American Thoracic Society has published an official clinical practice guideline in which a multidisciplinary panel of experts provide 13 conditional recommendations on the diagnostic testing and clinical management of these young people. The complete guideline detailing these recommendations was posted online ahead of print in the American Journal of Respiratory and Critical Care Medicine.
Worldwide, approximately 12 million infants—10 percent of live births—are born prematurely andare at risk for respiratory disease, the most common of which is bronchopulmonary dysplasia (BPD). However, all premature infants, even those who do not meet the criteria for having BPD, may develop poor respiratory health later in life with signs and symptoms including cough, recurrent wheezing, exercise intolerance, low blood oxygen (hypoxemia) and reduced pulmonary function. These individuals are classified as having PPRD.
In 2003, the ATS published the Statement on the Care of the Child with Chronic Lung Disease of Infancy (CLDI) and Childhood, which addressed the epidemiology, pathophysiology and treatment of CLDI in full-term and preterm infants. Therapeutic advances such as antenatal steroids, postnatal surfactant and protective ventilation strategies have led to significant increases in the survival of premature infants born much earlier in gestation. These increases in survival have led to an urgent need for physician guidance on the treatment of patients with lung disease associated with premature birth.
“There was a pressing need for updated guidance for clinicians who treat these patients,” stated panel co-chairs A. Ioana Cristea, MD, MS and Christopher D. Baker, MD, pediatric pulmonologists from Riley Hospital for Children (Indianapolis, Indiana) and the University of Colorado School of Medicine (Denver, Colorado), respectively. “These recommendations are intended to aid clinicians in the outpatient management of patients with PPRD, regardless of the degree of prematurity, the severity of disease or the age of the patient at the time of presentation.”
The panel included 26 experts in pediatric pulmonology, neonatology, sleep medicine, radiology and nursing as well as parents of children with PPRD. They used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to formulate questions, identify and summarize relevant evidence, and develop recommendations for clinical practice. They identified seven questions on the management of PPRD. A number of the recommendations address multiple issues within each question posed; in these cases, recommendations are abbreviated and multiple recommendations for each question are combined for the sake of brevity of this news release. To read the complete recommendations, please go to the guideline, found here.
All recommendations are conditional and based on very low-certainty evidence.
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