Respiratory disease

ATS: New Guidelines for Post-Prematurity Respiratory Disease

The American Thoracic Society has released a new clinical practice guideline on the diagnosis and outpatient management of post-prematurity respiratory disease (PPRD) in infants, children, and adolescents.1

This new, evidence-based guideline supplements the group’s 2003 guidelines on the management of children with chronic lung disease of infancy (CLDI). New research has suggested that premature infants who do not meet the definition for bronchopulmonary dysplasia, the most common CLDI, may still develop PPRD later in life.

Among the 13 conditional recommendations are:

  • A trial of short-acting inhaled bronchodilator therapy with monitoring is recommended for infants, children, and adolescents who have recurrent respiratory symptoms but should not be routinely prescribed to patients without these symptoms.
  • A trial of inhaled corticosteroids with monitoring is recommended for individuals with chronic cough and recurrent wheezing but should not be routinely prescribed to patients without these symptoms.
  • The use of a polysomnography and/or a sleep medicine referral is recommended for individuals with symptoms of sleep-disordered breathing, such as persistent snoring, failure to thrive, or a persistent need for supplemental oxygen at age 2 years.
  • Airway endoscopy is recommended for individuals with unexplained symptoms such as chronic cough, wheezing, ventilator dependence, persistent hypoxemia, or a history of patent ductus arteriosus ligation with stridor and weak cry.

“There was a pressing need for updated guidance for clinicians who treat these patients,” said the writing panel cochairs A. Ioana Cristea, MD, MS, and Christopher D. Baker, MD, in a press release.2 “These recommendations are intended to aid clinicians in the outpatient management of patients with PPRD, regardless of the degree of prematurity, the severity of the disease or the age of the patient at the time of presentation.”


—Leigh Precopio




  1. Cristea AI, Ren CL, Amin R, et al. Outpatient respiratory management of infants, children, and adolescents with post-prematurity respiratory disease: an official American Thoracic Society clinical practice guideline. Am J Respir Crit Care. 2021;204(12):e115-e133.
  2. Outpatient management of patients with post-prematurity respiratory disease. News release. American Thoracic Society; December 21, 2021. Accessed December 21, 2021.