Moshe Prero, MD, says bronchopulmonary dysplasia remains relevant into adulthood and details home safety priorities for children with tracheostomies.
A 2024 review conservatively estimated 1,000,000 survivors of BPD in the US and described the literature on adult survivors as “scant.”² At the
"It might look like asthma, but there might be underlying causes," said Prero, describing adults with a history of BPD who present with respiratory symptoms. He said these causes can track back to the neonatal course.
Prero said BPD severity varies widely, from supplemental oxygen to invasive mechanical ventilation through a tracheostomy, and each child's course can differ through adulthood. Patients have an elevated incidence of obstructive lung disease, according to Prero, although the full extent of long-term risk remains unknown.
Early imaging does not reliably predict later disease. Some children with severe CT findings in infancy do not have severe lung disease when older, and some with subtle early findings develop more severe disease with age.
Prero advised clinicians to treat prematurity as a permanent part of the medical history, noting records may not follow children who move between states or health care systems. He recommended screening for swallowing dysfunction, aspiration risk, and sleep-disordered breathing, each of which can affect lung disease.
Shortness of breath should prompt a diagnostic evaluation extending beyond the lungs, Prero said. He cited pulmonary hypertension and larger airway involvement as examples, adding unaddressed tracheomalacia in childhood can predispose patients to recurrent infections.
The 2025 American Thoracic Society (ATS) guideline strongly recommends an awake and alert trained caregiver always be present with children at risk of immediate decompensation from tracheostomy-related complications, based on very low certainty evidence.4 Prero described this requirement as a large burden for families and tied it directly to mortality risk.
"These children are at high risk for mortality if they have a tracheostomy and a ventilator at home," Prero said.
He pointed to 2 specific hazards. Small-diameter tubes can become obstructed by mucus, and active children can accidentally decannulate. In either event, Prero said, a trained and awake caregiver needs to be at the child's side and know how to respond.
The guideline also recommends a standardized discharge process with comprehensive family caregiver training for safe transitions from hospital to home, a conditional recommendation.4
Prero described multidisciplinary care as ideal, although these teams are often concentrated in cities or areas with tertiary care centers. He said collaboration may take the form of a single clinic bringing together pulmonology, otolaryngology, palliative care, respiratory therapy, and speech therapy.
In other cases, specialists may practice at separate locations, requiring patients to travel or use another form of monitoring. Prero said communication among team members is necessary in either model.
He identified 2 areas for further research. The first is tracheostomy infection, since cultures from these patients often grow bacteria of uncertain significance. The second is perioperative care; Prero said better stratification of unplanned readmission risk could help clinicians determine who should recover in the ICU, in a step-down unit, or at home.
“If we could figure that out, we'd be able to make life easier for both the families and the patients,” he said.
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