Premature babies: all about their fragile lungs 2026

Have cases of premature babies increased? Has your survival increased? Why has it been? What treatments have been discovered? Are there lung differences being born in the second trimester of pregnancy versus the third? These, and many other questions, were resolved during the last Congress of the Spanish Association of Pediatrics held from June 5 to 7 in Madrid. Dr. Manuel Sánchez Luna, head of the Neonatology Service at the Gregorio Marañón Hospital in Madrid and President of the Standards Commission of the Spanish Society of Neonatology (SENeo), explained the respiratory consequences of premature birth.

We spoke with Dr. Sánchez Luna, one of the leading specialists in the area of ​​neonatology in our country, about the increase in survival of the most immature babies that has led to them witnessing a new form of chronic lung disease, whose fundamental characteristic is the interruption of lung growth after birth.

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In the sixties, bronchopulmonary dysplasia was described based on the changes that occurred in the lungs of premature newborns. These generally presented a condition of respiratory failure, due to a defect in the production of surfactant. These patients had to be connected to mechanical ventilation equipment with a high concentration of oxygen that damaged the babies' immature lungs. All this made the lung damage permanent and serious.

Nowadays, and mainly since the late 90s, we have better care in the treatment and prevention of premature newborns. One of the greatest advances has been the discovery that the administration of corticosteroids to mothers at risk of having a premature birth significantly reduced the development of respiratory distress, stabilized the cerebral vascularization of the babies, and reduced the risk of death.

Along with these discoveries, the use of exogenous pulmonary surfactant has become widespread for the treatment of respiratory failure in premature newborns. These two have been the most important advances in neonatology, and have meant that the respiratory problems of premature babies are less serious and are better treated.

We also have new respiratory aid equipment that is non-invasive, that is, it is not necessary to place endotracheal tubes, so the trauma to the airway has been considerably reduced. The objective is not to intubate babies after birth, and only in the most serious cases when this is necessary to apply less aggressive ventilation concepts. All these advances have meant that premature babies suffer less damage to their lungs and do not develop bronchopulmonary dysplasia as before.

Now much more immature premature babies are born (less than 26 weeks of gestation). In these babies, and regardless of how we treat them, there is a stagnation in the growth of the lungs and this lack of postnatal growth fundamentally causes chronic respiratory failure that we today know as new Bronchopulmonary Dysplasia (BPD). This disease is more serious the more premature the baby is born, and when other factors are added, such as an infection before birth or lack of treatment with prenatal corticosteroids.

Apnea attacks are due to the immaturity of the respiratory center and not to Bronchopulmonary Dysplasia, however when a baby has BPD it is more common for them to have any type of associated respiratory problems.

The only effective way to prevent it is to avoid the birth of very premature babies, basically those born before the 26-28th week of pregnancy. As this is very complex as many factors coincide, the fundamental thing is to reduce the added damage to the immature lung by avoiding birth without administering a complete course of antenatal corticosteroids to the mother and for the birth to take place in centers with very high training in the care of these babies. The first minutes are essential in preventing further respiratory problems, which is why it is critical that these babies are born in centers with extensive experience in the respiratory management of these premature babies.

All premature newborns have affected lung function during their growth, but this is more striking in babies who develop BPD. As with all diseases, there are varying degrees that have a lot to do with how severe your respiratory disease was at birth. Therefore, recovery can be practically complete with a normal quality of life or have great functional limitations. This is why any additional damage to the lungs must be avoided from the moment of birth.

We know from the lung development of babies who were premature that there is a progressive recovery of the breathing function, however in all of them there is a limitation to the speed with which the gas moves in the lungs. This is what is called an obstructive pattern, and the bronchi of these babies sometimes respond in an exaggerated manner to respiratory infections and other toxic agents such as tobacco smoke. In these children, respiratory hygiene is very important, avoiding respiratory infections that would worsen the evolution of their disease.

A life with healthy habits is basic in these patients. Preventing exposure to toxins such as tobacco smoke is essential. Hygiene and handwashing of caregivers to reduce the risk of transmission of respiratory viruses is cheap and very effective.

In babies at higher risk, those born prematurely and even more so if they have BPD, it is necessary to reduce contact with certain viruses such as respiratory syncytial virus, which in epidemic times is the main cause of hospital admissions for bronchiolitis in this population. Prevention at this time by taking extreme care such as contact with people with respiratory symptoms, hand washing, maintaining breastfeeding in the first 6 months of life and avoiding contact with children who attend daycare is very effective. The administration of a specific monoclonal antibody called Palivizumab is the only pharmacological treatment that has proven effective, significantly reducing the risk of hospital admission and the severity of respiratory symptoms.

Una vida con hábitos saludables es básico en estos pacientes. La prevención de la exposición a tóxicos como el humo del tabaco es fundamental. La higiene y el lavado de manos de sus cuidadores para reducir el riesgo de transmisión de virus respiratorios es barato y muy efectivo.

En los bebés de mayor riesgo, aquellos que nacieron prematuros y más aún si tienen una DBP, es necesario reducir el contacto con ciertos virus como el respiratorio sincitial que en época epidémica es el mayor causante de los ingreso hospitalarios por bronquiolitis en esta población. La prevención en esta época extremando los cuidados como es el contacto con personas con cuadros respiratorios, el lavado de manos, el mantenimiento de la lactancia materna en los primeros 6 meses de vida y evitar el contacto con niños que acuden a guarderías es muy eficaz. La administración de un anticuerpo específico monoclonal llamado Palivizumab, es el único tratamiento farmacológico que ha demostrado su eficacia, reduciendo el riesgo de ingreso hospitalario y la gravedad de los cuadros respiratorios de forma significativa.