ATS GUIDELINES Bundle

Treatment ➤ Premature birth affects millions of neonates each year, placing them at risk for respiratory disease due to prematurity. ➤ Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease of infancy, but recent data suggest that even premature infants who do not meet the strict definition of BPD can develop adverse pulmonary outcomes later in life. ➤ This post-prematurity respiratory disease (PPRD) manifests as chronic respiratory symptoms including cough, recurrent wheezing, exercise limitation, and reduced pulmonary function. Recommendation 1a ➤ For infants, children, and adolescents with PPRD who do not have recurrent respiratory symptoms, the ATS suggests that short-acting inhaled bronchodilator therapy NOT be routinely prescribed (conditional recommendation, very low-certainty evidence). Recommendation 1b ➤ For infants, children, and adolescents with PPRD who have recurrent respiratory symptoms (such as cough or wheeze), the ATS suggests a trial of short-acting inhaled bronchodilator with monitoring to assess for clinical improvement in symptoms (conditional recommendation, very low-certainty evidence). Recommendation 2a ➤ For infants, children, and adolescents with PPRD who do not have chronic cough and recurrent wheezing, the ATS suggests that inhaled corticosteroids NOT be routinely prescribed (conditional recommendation, very low-certainty evidence). Recommendation 2b ➤ For infants, children, and adolescents with PPRD who have chronic cough or recurrent wheezing, the ATS suggests a trial of inhaled corticosteroids with monitoring to assess for clinical improvement in symptoms (conditional recommendation, very low-certainty evidence). Recommendation 3a ➤ For infants, children, and adolescents with PPRD, the ATS suggests AGAINST the routine use of diuretics (conditional recommendation, very low-certainty evidence). Recommendation 3b ➤ For infants with PPRD who are discharged from the neonatal intensive care unit (NICU) on chronic diuretic therapy, the ATS suggests discontinuation in a judicious manner (conditional recommendation, very low-certainty evidence). Treatment

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