{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T21:41:18Z","timestamp":1775166078582,"version":"3.50.1"},"reference-count":44,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Respiratory morbidity in preterm infants has been widely studied, with evidence showing that individuals born prematurely experience more frequent respiratory symptoms, airflow obstruction, and radiological lung abnormalities throughout life. Methods: This study included 150 children aged 6 to 11 years, divided into two groups. The preterm group (n = 90) consisted of children born before 32 weeks of gestation, while the control group (n = 60) included term-born children. All participants underwent spirometry and completed a respiratory health questionnaire. Results: A significantly higher proportion of preterm children exhibited respiratory morbidity compared to term-born peers (\u03c72 = 7.035; p = 0.030). However, no significant differences were found between preterm children with and without bronchopulmonary dysplasia (BPD) defined at day 28 (BPD28) (\u03c72 = 0.002; p = 0.968) or BPD defined at 36 weeks postmenstrual age (BPD36) (\u03c72 = 0.029; p = 0.864). Lung function parameters\u2014forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1\/IVC, maximal expiratory flow at 25%, 50% and 75% of FVC (MEF25, MEF50, and MEF75) were significantly lower in the preterm group (p = 0.004 for FVC and p &lt; 0.001 for all other parameters). No significant differences were observed between BPD and non-BPD subgroups in any lung function parameter. BPD36 was found to be a stronger predictor of respiratory morbidity (OR = 1.214) than BPD28 (OR = 1.093), although neither BPD28 nor BPD36 were statistically significant predictors. Conclusions: This study underscores the long-term respiratory consequences of prematurity and challenges the traditional view of BPD as the primary determinant of poor respiratory outcomes. Our findings suggest that prematurity itself, rather than BPD, may play a more central role.<\/jats:p>","DOI":"10.3390\/children13010005","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T11:03:46Z","timestamp":1766142226000},"page":"5","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Respiratory Sequelae of Prematurity in School-Age Children: Is Bronchopulmonary Dysplasia Still the Primary Risk Factor?"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1702-0270","authenticated-orcid":false,"given":"Milena","family":"Bjelica","sequence":"first","affiliation":[{"name":"Institute for Child and Youth Health Care of Vojvodina, Hajduk Veljkova 10, 21000 Novi Sad, Serbia"},{"name":"Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5430-577X","authenticated-orcid":false,"given":"Gordana","family":"Vilotijevi\u0107 Dautovi\u0107","sequence":"additional","affiliation":[{"name":"Institute for Child and Youth Health Care of Vojvodina, Hajduk Veljkova 10, 21000 Novi Sad, Serbia"},{"name":"Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2102-7336","authenticated-orcid":false,"given":"Slobodan","family":"Spasojevi\u0107","sequence":"additional","affiliation":[{"name":"Institute for Child and Youth Health Care of Vojvodina, Hajduk Veljkova 10, 21000 Novi Sad, Serbia"},{"name":"Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2350-6508","authenticated-orcid":false,"given":"Tanja","family":"Radovanovi\u0107","sequence":"additional","affiliation":[{"name":"Institute for Child and Youth Health Care of Vojvodina, Hajduk Veljkova 10, 21000 Novi Sad, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3169-1380","authenticated-orcid":false,"given":"Milica","family":"Plaza\u010di\u0107","sequence":"additional","affiliation":[{"name":"Institute for Child and Youth Health Care of Vojvodina, Hajduk Veljkova 10, 21000 Novi Sad, Serbia"},{"name":"Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Kumar, V.H.S. (2023). Special Issue: Prematurity, Preterm-Born Adults, and Long-Term Effects on Children and Adults. Children, 10.","DOI":"10.3390\/children10060989"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1136\/postgradmedj-2014-206590rep","article-title":"Lung Consequences in Adults Born Prematurely","volume":"91","author":"Bolton","year":"2015","journal-title":"Postgrad. Med. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"240114","DOI":"10.1183\/16000617.0114-2024","article-title":"Impaired Lung Function and Associated Risk Factors in Children Born Prematurely: A Systematic Review and Meta-Analysis","volume":"33","author":"Hutten","year":"2024","journal-title":"Eur. Respir. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2000202","DOI":"10.1183\/13993003.00202-2020","article-title":"Early Childhood Respiratory Morbidity and Antibiotic Use in Ex-Preterm Infants: A Primary Care Population-Based Cohort Study","volume":"56","author":"Tan","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1007\/s00431-017-2849-4","article-title":"First versus Second Year Respiratory Syncytial Virus Prophylaxis in Chronic Lung Disease (2005\u20132015)","volume":"176","author":"Wang","year":"2017","journal-title":"Eur. J. Pediatr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1111\/apa.13165","article-title":"Respiratory Illness Contributed Significantly to Morbidity in Children Born Extremely Premature or with Extremely Low Birthweights in 1999\u20132000","volume":"104","author":"Skromme","year":"2015","journal-title":"Acta Paediatr."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Caffarelli, C., Gracci, S., Giann\u00ec, G., and Bernardini, R. (2023). Are Babies Born Preterm High-Risk Asthma Candidates?. J. Clin. Med., 12.","DOI":"10.3390\/jcm12165400"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1136\/thorax-2022-218931","article-title":"Preterm or Early Term Birth and Long-Term Risk of Asthma into Midadulthood: A National Cohort and Cosibling Study","volume":"78","author":"Crump","year":"2023","journal-title":"Thorax"},{"key":"ref_9","unstructured":"National Heart, Lung, and Blood Institute, National Institutes of Health (1979). Workshop on Bronchopulmonary Dysplasia. Sponsored by the Division of Lung Diseases. J. Pediatr., 95, 815\u2013920."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1542\/peds.82.4.527","article-title":"Abnormal Pulmonary Outcomes in Premature Infants: Prediction from Oxygen Requirement in the Neonatal Period","volume":"82","author":"Shennan","year":"1988","journal-title":"Pediatrics"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1164\/ajrccm.163.7.2011060","article-title":"Bronchopulmonary Dysplasia","volume":"163","author":"Jobe","year":"2001","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.jpeds.2018.01.043","article-title":"Bronchopulmonary Dysplasia: Executive Summary of a Workshop","volume":"197","author":"Higgins","year":"2018","journal-title":"J. Pediatr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1164\/rccm.201812-2348OC","article-title":"The Diagnosis of Bronchopulmonary Dysplasia in Very Preterm Infants: An Evidence-Based Approach","volume":"200","author":"Jensen","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1002\/ppul.22676","article-title":"Lung Function Outcome at School Age in Very Low Birth Weight Children","volume":"48","author":"Cazzato","year":"2013","journal-title":"Pediatr. Pulmonol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1093\/aje\/154.6.521","article-title":"Respiratory Symptoms at Age 8 Years in a Cohort of Very Low Birth Weight Children","volume":"154","author":"Palta","year":"2001","journal-title":"Am. J. Epidemiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1136\/adc.2008.140830","article-title":"Respiratory Health in Pre-School and School Age Children Following Extremely Preterm Birth","volume":"93","author":"Hennessy","year":"2008","journal-title":"Arch. Dis. Child."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1164\/rccm.200912-1806OC","article-title":"Lung Function and Respiratory Symptoms at 11 Years in Children Born Extremely Preterm: The EPICure Study","volume":"182","author":"Fawke","year":"2010","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Jain, D., Feldman, A., and Sangam, S. (2020). Predicting Long-Term Respiratory Outcomes in Premature Infants: Is It Time to Move beyond Bronchopulmonary Dysplasia?. Children, 7.","DOI":"10.3390\/children7120283"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"121","DOI":"10.3233\/NPM-181756","article-title":"Bronchopulmonary Dysplasia Appropriateness as a Surrogate Marker for Long-Term Pulmonary Outcomes: A Systematic Review","volume":"11","author":"Corwin","year":"2018","journal-title":"J. Neonatal-Perinat. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"170108","DOI":"10.1183\/16000617.0108-2017","article-title":"How Best to Capture the Respiratory Consequences of Prematurity?","volume":"27","author":"Ciuffini","year":"2018","journal-title":"Eur. Respir. Rev."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"S59","DOI":"10.1002\/ppul.27304","article-title":"Long-Term Respiratory Consequences of Prematurity","volume":"60","author":"Pijnenburg","year":"2025","journal-title":"Pediatr. Pulmonol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1900788","DOI":"10.1183\/13993003.00788-2019","article-title":"European Respiratory Society Guideline on Long-Term Management of Children with Bronchopulmonary Dysplasia","volume":"55","author":"Duijts","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_23","first-page":"158","article-title":"Follow-Up del Bambino con Dysplasia Broncopolmonare","volume":"18","author":"Cazzato","year":"2017","journal-title":"Area Pediatr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1136\/thoraxjnl-2021-218400","article-title":"Tracking of Lung Function from 10 to 35 Years after Being Born Extremely Preterm or with Extremely Low Birth Weight","volume":"77","author":"Benestad","year":"2022","journal-title":"Thorax"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1002\/ppul.23919","article-title":"Lung Function after Extremely Preterm Birth\u2014A Population-Based Cohort Study (EXPRESS)","volume":"53","author":"Thunqvist","year":"2018","journal-title":"Pediatr. Pulmonol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1136\/thoraxjnl-2012-202980","article-title":"Lung Function after Preterm Birth: Development from Mid-Childhood to Adulthood","volume":"68","author":"Eide","year":"2013","journal-title":"Thorax"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1164\/rccm.201712-2599LE","article-title":"Longitudinal Assessment of Lung Function in Survivors of Bronchopulmonary Dysplasia from Birth to Adulthood: The Padova BPD Study","volume":"198","author":"Moschino","year":"2018","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1002\/ppul.23422","article-title":"Mid-Childhood Lung Function in a Cohort of Children with \u201cNew Bronchopulmonary Dysplasia\u201d","volume":"51","author":"Fortuna","year":"2016","journal-title":"Pediatr. Pulmonol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"00046-2023","DOI":"10.1183\/23120541.00046-2023","article-title":"Increasing Airway Obstruction through Life following Bronchopulmonary Dysplasia: A Meta-Analysis","volume":"9","author":"Gibbons","year":"2023","journal-title":"ERJ Open Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1136\/thoraxjnl-2012-203079","article-title":"Effect of Preterm Birth on Later FEV1: A Systematic Review and Meta-Analysis","volume":"68","author":"Kotecha","year":"2013","journal-title":"Thorax"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1002\/ppul.23487","article-title":"Respiratory Function and Symptoms in Young Preterm Children in the Contemporary Era","volume":"51","author":"Verheggen","year":"2016","journal-title":"Pediatr. Pulmonol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1590\/S1807-59322011000300011","article-title":"Respiratory Outcomes and Atopy in School-Age Children Who Were Preterm at Birth, with and without Bronchopulmonary Dysplasia","volume":"66","author":"Rocha","year":"2011","journal-title":"Clinics"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"19616","DOI":"10.1038\/s41598-020-76614-0","article-title":"Asthma Prevalence, Lung and Cardiovascular Function in Adolescents Born Preterm","volume":"10","author":"Arroyas","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1111\/j.1440-1754.2007.01001.x","article-title":"Chronic Lung Disease of Prematurity and Respiratory Outcome at Eight Years of Age","volume":"43","author":"Kulasekaran","year":"2007","journal-title":"J. Paediatr. Child Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1542\/peds.2005-2522","article-title":"Bronchopulmonary Dysplasia in Very Low Birth Weight Subjects and Lung Function in Late Adolescence","volume":"118","author":"Doyle","year":"2006","journal-title":"Pediatrics"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3156","DOI":"10.1002\/ppul.26636","article-title":"Lung Function Deficits and Bronchodilator Responsiveness at 12 Years of Age in Children Born Very Preterm Compared with Controls Born at Term","volume":"58","author":"Hagman","year":"2023","journal-title":"Pediatr. Pulmonol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2101766","DOI":"10.1183\/13993003.01766-2021","article-title":"Association of Early-Life Factors with Prematurity-Associated Lung Disease: Prospective Cohort Study","volume":"59","author":"Hart","year":"2022","journal-title":"Eur. Respir. J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"3151","DOI":"10.1002\/ppul.26151","article-title":"Influence of Bronchopulmonary Dysplasia on Lung Function in Adolescents Who Were Born Extremely Prematurely","volume":"57","author":"Harris","year":"2022","journal-title":"Pediatr. Pulmonol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1136\/thoraxjnl-2016-208985","article-title":"Altered Lung Structure and Function in Mid-Childhood Survivors of Very Preterm Birth","volume":"72","author":"Simpson","year":"2017","journal-title":"Thorax"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Ronkainen, E., Dunder, T., Peltoniemi, O., Kaukola, T., Marttila, R., and Hallman, M. (2015). New BPD Predicts Lung Function at School Age: Follow-Up Study and Meta-Analysis. Pediatr. Pulmonol., 1098.","DOI":"10.1002\/ppul.23153"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1038\/jp.2015.124","article-title":"Respiratory Morbidity, Lung Function and Fitness Assessment after Bronchopulmonary Dysplasia","volume":"35","author":"Praprotnik","year":"2015","journal-title":"J. Perinatol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1002\/ppul.25226","article-title":"Respiratory Outcomes of \u201cNew\u201d Bronchopulmonary Dysplasia in Adolescents: A Multicenter Study","volume":"56","year":"2021","journal-title":"Pediatr. Pulmonol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2922","DOI":"10.1002\/ppul.27158","article-title":"Long-Term Lung Function Follow-Up of Preterm Infants Less than 32 Weeks of Gestational Age","volume":"59","year":"2024","journal-title":"Pediatr. Pulmonol."},{"key":"ref_44","first-page":"867","article-title":"Geographical Differences and Temporal Improvements in Forced Expiratory Volume in 1 Second of Preterm-Born Children: A Systematic Review and Meta-Analysis","volume":"176","author":"Kotecha","year":"2022","journal-title":"JAMA Pediatr."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/1\/5\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T11:31:20Z","timestamp":1766143880000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/1\/5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,19]]},"references-count":44,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["children13010005"],"URL":"https:\/\/doi.org\/10.3390\/children13010005","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,19]]}}}