This week I received a photo of one of our NICU grads on his way to his first day in daycare. It was a big day for the whole family. For many of our graduates, the first day of "school" is a long-time coming. For those of you who do not know this, many premature infants (and some term ones too) have long-term respiratory issues. This makes them more susceptible to all kinds of respiratory illnesses. For this reason (and others), it is usually recommended that NICU infants not be exposed to large crowds, sick people, small children, or daycare centers until their systems are more mature.
Why are they more susceptible? Scientists and researchers have been asking that for years. They also want to find out just how long this increased susceptibility lasts. One study found that premature infants (30-34 weeks) had decreased lung capacity up to two years after birth compared to term infants and that premature infants' lung growth does not "catch-up" (Friedrich, et al., 2007). A 2010 study on infants born at 25 weeks or less found:
"At 11 years of age, 56% of children born before 25+6 weeks of gestation had abnormal baseline spirometry,27% had a positive bronchodilator response, and 25% had a diagnosis of asthma (twice that observed in classmates). Among the 65% of extremely preterm children who had been asymptomatic over the previous 12 months, 48% had abnormal baseline spirometry, of whom 81% had prior bronchopulmonary dysplasia, emphasizing the need for continued monitoring of these children" (Fawke, et al., 2010).
This means that parents of preemies need to be vigilant about infection control (such as handwashing and exposure to others) and monitoring of their baby's respiratory status. Immunizations and RSV prophylaxis (for those that qualify) are important things to discuss with your pediatrician.
Little is known about more recent NICU grads' long-term respiratory function. As Fawke, et al. (2010) pointed out, recent graduates are typically more immature, but have been exposed to "less agressive ventilatory support".
We have come a long way in neonatology practice and we still have more to learn. It is hoped that in years to come these statistics will be very different.....we'll have to watch and see.
Julie Hudson, MSN, RN
Fawke, J., Lum, S. Kirkby, J. Hennessy, E., Marlow, N., Rowell, V., Thomas, S. and Stocks, J. (2010). Lung function and respiratory symptoms at 11 years in children born extremely premature: The EPICure program. American Journal of Respiratory and Critical Care Medicine, 182, 237-245.
Friedrich, L., Pitrez, P.M., Stein, R.T., Goldani, M., Tepper, R. and Jones, M.H. Growth rate of lung function in healthy preterm infants. American Journal of Respiratory and Critical Care Medicine, 176, 1269-1273.