Despite many improvements in neonatal care, prematurity remains a significant cause of childhood mortality and morbidity, and the second largest cause of death in children worldwide.1 2 Chronic lung disease of prematurity, also known as bronchopulmonary dysplasia (BPD) is the most common respiratory complication, associated with poor long-term health and neurodisability.3 Early lung protective ventilation strategies can affect lung function and respiratory outcomes long into school age.4

In this issue of Thorax, Kwok et al describe changes in the outcomes of preterm babies in England and Wales over the last decade (2010–2020).5 Important findings of this cohort study are increase in the overall survival, accompanying increase in the BPD incidence among survivors and increase in the use of postnatal steroids. Furthermore, incidence of severe BPD and proportion of infants requiring respiratory support after discharge has increased.

There are well-documented health consequences of prematurity, although consistent respiratory follow-up is lacking:

Prematurely born infants suffer troublesome respiratory symptoms during infancy and childhood.6 Adolescents and adults born preterm are reported to have airway obstruction and reduced exercise tolerance, with worse performance in preterm infants diagnosed with BPD. The diagnosis of asthma is twofold more common.7 8

Pulmonary hypertension (PH) is common in BPD and is associated with increased mortality and morbidity.9 Worryingly, evidence from prospective cohorts have shown four times increase in mortality in babies …