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Decreasing the risk on respiratory tract infections and wheezing in this group is vital to improve quality of life and reduce medical consumption during infancy, but also to reduce the risk on asthma and COPD later in life. Until now, moderate\u2010late preterm infants are underrepresented in research and mechanisms underlying their morbidity are largely unknown, although they represent 80% of all preterm\u2010born infants. In order to protect these infants effectively, it is essential to understand the role of the immune system in early life respiratory health and to identify strategies to optimize immune development and respiratory health. This review elaborates on risk factors and preventative measures concerning respiratory tract infections and wheezing in preterm\u2010born infants, exploring their impact on the immune system and microbiome. Factors discussed are early life antibiotic use, birth mode, feeding type and living environment. Further, differences in adaptive and innate immune maturation between term and preterm infants are discussed, as well as differences in local immune reactions in the lungs. Finally, preventative strategies are being explored, including microbiota transplantation, immune modulation (through pre\u2010, pro\u2010, syn\u2010 and postbiotics, bacterial lysates, vaccinations, and monoclonal antibodies) and antibiotic prophylaxis.<\/jats:p>","DOI":"10.1111\/all.16342","type":"journal-article","created":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T06:35:17Z","timestamp":1728455717000},"page":"2924-2942","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["The developing immune system in preterm born infants: From contributor to potential solution for respiratory tract infections and wheezing"],"prefix":"10.1111","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-5559-5191","authenticated-orcid":false,"given":"Inger C.","family":"van Duuren","sequence":"first","affiliation":[{"name":"Department of Paediatrics Franciscus Gasthuis &amp; Vlietland  Rotterdam The Netherlands"},{"name":"Department of Pediatrics, Division of Respiratory Medicine and Allergology Sophia Children's Hospital \u2010 Erasmus MC  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar R. 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