The long term effect of underdeveloped lungs in prem babies

[TortoiseInAShell]

My baby was premature but not a huge amount like some people experience, only born at 35 weeks. However, it was premature enough for me to have to receive the steroid injection before baby was born, to help protect his lungs.

For about 5 months every winter since we've had countless steroid courses for his lungs, usually due to croup and various respiratory infections. Sometimes he will have antibiotics as well, but mostly just a course of oral steroids.

My understanding was that you can expect this for the first couple of years in a baby born early. But my SIL keeps repeatedly undermining this by telling my family that I am wrong, in her expert opinion there is no correlation between premature babies and chest problems in the first few winters. Yesterday she was going on about how my baby wasn't all that early either, making it sound like I was especially being a PFB parent, even though this is not my first baby!

Has anyone else heard of this? I know gp's aren't always right but SIL keeps batting down what I am passing on to my family and making me look like I am making a mountain out of a molehill when all I am doing is passing on what I've been told by a GP.

Does anyone else have experience of mild prematurity that affected he developing lungs for a few winters? I am starting to doubt myself

Ds was born at 34 weeks due to IUGR, had the steroids and has chest problems. His presented a lot as a funny wheezy cough and every cold went into his chest. They've put it down to asthma now at 7yo but no asthma or allergies run through my family. I honestly believe it has been a case of him being born early has contributed to this. He has got slightly better every year I have to say and after being put on montelustkast the past year has been brilliant, only the odd chest problems rather than missing loads of school like previous years.

Thanks for your answer. Did any of your GP's suggest it could be due to being born a bit early?

No gps no but I don't think they like to put a definite reason on things. A couple of nurses have said it as he has been hospitalised a few times with his chest. Was your ds on oxygen at all after he was born?

No he was fine at the time, we stayed in hospital for 10 days because he was too immature to suck yet.

I wonder for helped that he was born mid-summer, and didn't need steroids until the Autumn, several courses in the winter and then again in the spring.

My DS was born at 35+0 and I also had the steroid injections before he was born. No chest problems here, although he does pick up every cold going (normal for a 3 year old in nursery?). He did breathe fine on his own when he was born though, no need for oxygen.

I think that your SIL is talking rubbish.

Premature babies are more likely than babies born at term to have respiratory problems - I've read articles based on actual research (rather than someone's unfounded opinion) reporting this but can't link on tablet.

It's more likely the more premature a baby was, and it's not a given thing that all premature babies will go on to have long term respiratory problems. DS1 was born at 34+1, had the steroids to help develop his lungs, and was on CPAP for the first few days, but in his case, he's had no more respiratory infections than a typical full-term baby.

But DS1 having no chest problems doesn't change the fact that premature babies are more likely to have long term chest problems than other babies.

Seriously, I'd ignore your SIL about this.

Thanks Shadow. I understand you can't link that article but do you have any idea how I could find it online?

Is your DSL a doctor or more particularly a chest /respiratory illnesses consultant or a pediatritian.
If she isn't then I would say " that's your opinion - I'd prefer to go by what my doctor told me - after all you aren't a doctor are you ?"
Obviously if she is then maybe she has got access to research and may know what she is actually talking about.
Anyway - does it matter it may have no bearing your ds may have had a tendency to chest complaints had he been born full term - you don't know and even if it's connected or not unless it actually affects his treatments going forward it's irrelevant.

I'll see if I can dig it out later, it was a while ago I read it, and DH has just reminded me that my parents are due round in 30 mins...

Ironing - she's a nurse and fairly newly qualified one at that.

I suppose I am not naive enough to assume all gp's are right all the time, and because she works in Nicu it's hard to argue my case as she has more ground knowledge than me, and she'd say my gp!

Well an NICU nurse could be better placed than a gp to offer advice about issues surrounding prem babies. Of course, that doesn't mean that she is certainly right. The NICU nurses (and dr's) came out with some incredible nuggets when I was there (you should have seen my face when they told me that I couldn't carry on bfing my toddler because I'd run out of milk).

I wouldn't hold her lack of experience against her either, it could just as well go in her favour (recent training could mean that she's more up to date research wise than an experienced professional who hasn't been keeping up).

Could she actually be concerned that you and the gp are writing off the ongoing health problem as normal when she knows that many prem babies do not have any lasting respiratory problems? Maybe she thinks that it's something that should be investigated further?

DS2 was born at 26 weeks. He was hospitalised with bronchilitus twice in the first year, but for the next three years he's had nothing more than two short colds - much less than your average child.

I'd say, almost all health problems/behavioural problems are statistically more likely for prem babies, that doesn't mean that every problem should be written off as 'just because he's prem'. If you are worried, pursue it. If you're not, then don't.

four babies here 29-35 weeks and winter has always been tough. at 35 weeks you won't have the problems of say my 29 weeker who's next cold will leave him in ICU but you will have asthma type issues early on.

my 31 weeker really struggled for about two years and they said prematurity plus intubation meant she had weak lungs, that causes infections which leaves more scarring which makes her more prone. eventually they got aggressive with asthma treatment. what they said was that the lungs don't stretch like everything else it grows more lung so if we could prevent her getting ill the new lung would stay healthy and the damaged part would become a smaller part of whole lung. and now at 8 she's off everything and ok.

looking after babies at birth doesn't make you an expert in them growing up. most NNU staff will tell you iugr is a pregnancy condition and don't know the longterm affect it has.my oldest born baby is one of the worst hit, my youngests biggest issue is the neglect from the hospital so I don't count that. gestational age doesn't always mean a lot, I've seen premature postmature babies.

We were told something similar OP, but that the effect was greater for babies who have been on a ventilator or on oxygen.
We didn't have a great problem with dd born at 27 weeks, but this may be because she was discharged from hospital in the Spring and this gave her lots of growing time before the arrival of winter.
Most nurses have very little experience of prem babies. I used to bypass HV and go to GP who had worked in a NICU when she was training and therefore had more experience.
However dcs do reach a point (about 3 years old) when medical professionals wouldn't really expect being born prematurely to be the main contributing factor. Some babies born at full term still have chest problems and asthma and the medical treatment needed would be the same. So if you have reached the stage where this has gone on for longer than a couple of years perhaps as PP has said this needs to be investigated further now rather than just written off because he was prem.

How old is your ds OP? Please dont take this the wrong way but as a neonatal nurse she is going to be working day in day out with incredibly sick los who are likely to have life altering consequences of their prematurity. A 35 weeker given steroids - each dose of which ages the lungs about a week - essentially has the lungs of a term baby. And if no supplemental oxygen was needed that kind of confirms it. However neonatal nurses dont know much about premmies as they grow up. Yr dc will have an impaired immune system as antibodies are transferred in the last trimester. This is recognised in that vulnerable prems receive additional immunisations over their first few winters to protect against bronchiolitis. At a cost of 600 a month they are rationed and yr dc wouldnt meet any of the criteria - they were too term, large and healthy - so maybe thats what your sil is using as a benchmark?!? My dd was a 27 weeker and while her immune system benefitted because she was bf she

Sorry for split message. My dd was prone to respiratory infections for at least her first two winters. But then she had six weeks in oxygen starting from a vent - and that causes damage. When she got pneumonia at 18 months the docs said it was hard to tell from x-rays what was scarring and what was fresh damage. I think in your case its more likely to be immune system related and maybe sil means well, prems are more prone to asthma and allergies and maybe this needs looking at seriously as an ongoing thing. Hope this winter is kind for all our los. No hospital this year would be brilliant.

Working in the NICU is not the same as knowing about what happens to the babies after they are discharged. DD2 was 8 weeks prem, born in the spring, she suffered terribly with chest problems (infections, croup etc) every winter for her first five years or so. She spent months every winter on amoxicillin.
DS was born ten weeks early, lots of oxygen, Cpap etc, he technically has chronic lung disease, and he is much stronger chest wise. He still has problems though. Prem babies are def more likely to have chest problems

See my son was born at 33+5 he had steroids in the right amount of time before but when he was born everyone was shocked that he needed to be ventilated then cpap then oxygen I was told his lungs where immature even though he had the steroids. So I allways thought they did nothing for him but now he's 5 months old gets every cold and flu due to an immune problem but it never goes on his chest his chest is allways checked so I like to thing that's how they worked. But that's just what I like to think. But I've allways been told that prem babies get a lot of things creeping up usually due to there prematurity by alll his pediatricians and all the drs he's seen over the last few months

Hi OP. I don't know if prem babies are more prone to chest/lung probs but my ds was only 4.5 weeks prem and a very good weight but needed a ventilator. After leaving the NICU he had cold after cold that went to his chest, pneumonia and bronchiolitis a couple of times during his first years. He was finally diagnosed with asthma aged 7 and takes inhalers that mostly keep it under control but sometimes he needs montelukast as well. I have always assumed it's because he had such a difficult start in life but I guess in a way it doesn't matter so much - you just treat what symptoms they have - however I would be pissed off if someone was constantly contradicting what I said in regard to my ds so I think your sil is being a bit annoying!

The midwife advised me on discharge from SCBU that we should be prepared for a hospital admission in the winter for chesty colds. My LO was born at 32 weeks and luckily they have not suffered with chest problems despite only having time for 1 steroid injection and being on oxygen in the incubator for 10 days

Yes, any immaturity especially followed by early chest infections can go on to have long term consequences.
I imagine my ds2s consultant paed is better placed than your SIL to know.
We were also told while the nearer the due date the less likely to have problems there are always exceptions & all preterm babies are at increased risk. Otherwise why would they bother with steroids for the mother?
ds2 was born at 28wks, was ventilated, CPAP & then oxygen. He was discharged in the spring & I think that definitely helped but his first two years he was not particularly healthy.
He is 11 now & he does have some long term disabilities but his chest has improved hugely.

My son was born at 33 weeks in August 2013 and didn't need any help with breathing in NNU. He had an illness-free first winter. This winter, however (his second), he seems to have been unwell almost constantly since September. He has had croup three or four times, streaming nose, coughs, D&V, fevers...

My son was a 28 weeker (he is now 9 years old) was ventilated then cpap and nasal oxygen. The first few winters were pretty bad, he would cough so much his lips would turn blue and due to constantly coughing he was unable to eat and ripped a repaired hernia in his groin and made a new one. He was give a brown and blue inhaler which did help. We found he only needed the inhalers when unwell or after/during an extreme indoor play sessions and as the year have gone on he needs them less and less. He turned 9 in November and was ill over Christmas and the blue inhaler was used twice at night to help him sleep. Michael was oxygen dependant for almost his whole nicu stay which was 13 weeks and was almost sent home on oxygen but was weened off it just before we were allowed to take him home. Hopefully he will be off the inhaler completely this year he has come a very long way.

preemies.about.com/od/parentingyourpreemie/fl/Why-Preemies-are-at-an-Increased-Risk-for-RSV.htm