This study highlights the importance of assessing quality of life in preterm patients with BPD, particularly those with grade 2–3, as they have a worse perception of quality of life at school age.
Despite recent advancements in the survival rates of extremely preterm infants, the prevalence of respiratory sequel, particularly BPD, remains high (1, 2). Prior research indicates that patients diagnosed with BPD are at an increased risk of asthma and pulmonary function abnormalities compared to those without BPD (5, 19–22). However, there is no established consensus on the impact of this condition on quality of life.
The present study used the Pediatric Quality of Life Questionnaire (PedsQL) to evaluate the QoL of preterm infants during school age, focusing on four domains: “health & activities”, “emotional state”, “social activities”, and “school activities”. Patients with BPD 2–3 exhibited a significantly poorer perception of the “total quality of life” (p = 0.03) and in the “social activities” domain (p = 0.02) compared to those without BPD or with BPD 1, even after adjusting for gestational age in a multivariate model. In our sample of patients with BPD, the scores were higher (indicating poorer quality of life) than those reported in the study by W. Varni et al. (17), where the questionnaire was completed by healthy children.
Lee et al. conducted a systematic review in 2023 to analyze the impact of BPD on quality of life from three perspectives: caregivers' quality of life, caregivers' perception of patients' quality of life, and BPD patients' self-reported quality of life. The results highlighted difficulties experienced by patients and carers, including sleep problems and acute care needs, which negatively affected quality of life, particularly in the immediate post-discharge period. In this study, patients with BPD demonstrated physical QoL similar to preterm infants without BPD in late childhood and early adulthood (12). Additionally, Sudhir Sriram et al. and Wook Kim, S. et al. reported that patients without BPD had better perceived QoL than those with BPD (23, 24).
In our study population, no significant differences were observed in the "health & activities" domains, suggesting effective control and management of respiratory pathology during follow-up. However, significant disparities were found in the "social activities" domain, potentially related to findings described by Della Longa L et al. (25), who noted that preterm infants have difficulties recognizing facial emotions, which may impact their social skills. In light of these findings, it may be worth considering referring patients with BPD to psychological services to enhance their social skills, as research suggests that simple interventions can result in clinical improvement (26).
However, other authors have not found differences in quality of life in patients with BPD. Beaudoin et al found similar health-related quality of life and respiratory symptoms when comparing patients with a history of prematurity and bronchopulmonary dysplasia with healthy term controls, despite the fact that the former required greater use of health services and prescription drugs (27). Other authors also report no significant differences in quality of life between patients with BPD and healthy controls (14), and even find lower rates of depression, fatigue and pain in the BPD group (13).
In our study, we observed no significant differences in QoL between patients without BPD and those with grade I BPD, nor between those born before and after 28 weeks' gestation. This suggests that the presence of grade 2–3 BPD has a more substantial impact on perceived QoL than gestational age. The association between prematurity and altered QoL remains contentious, with some studies indicating a diminished perception of QoL in preterm infants compared to term infants, (28, 29), while others show no such correlation (30–32). Our findings align with previous research by Wook Kim, S. et al., who noted worse QoL perceptions in infants born before 26 weeks' gestational age but found that this effect disappeared when adjusted for BPD and other comorbidities (23). Zwiker et al. found a decreasing effect of prematurity/very low birth weight on health-related quality of life over time, but the heterogeneous nature of the studies limits definitive conclusions (33).
Additionally, among other perinatal factors considered, only the duration of invasive mechanical ventilation increased the risk of poorer QoL (adjusted for BPD). In line with our sample, other studies using the PedsQL scale have also found no association between low birth weight for gestational age and quality of life (34). As for other perinatal factors, there is currently no clear evidence that they are associated with changes in perceived quality of life.
Several limitations need to be acknowledged in our study. Firstly, we were unable to include a control group of healthy term infants due to challenges in adequately monitoring them. Additionally, as this was a single-center study, the generalizability of our results to other populations may be limited. Another significant limitation is the inability to include all preterm infants born during the study due to the extended follow-up period and loss to follow-up of several patients, which may introduce bias as healthier patients might have been more likely to maintain follow-up.
In conclusion, this study highlights the importance of assessing quality of life in preterm patients with BPD, particularly in those with grade BPD 2–3. The findings suggest that the presence of BPD 2–3, significantly impacts their perception of quality of life, particularly in aspects related to “social activities”. These results underscore the necessity for long-term follow-up, not only for the detection and treatment of medical issues but also for intervention in areas affecting quality of life. Moreover, given the lack of consensus in the literature and the variability in results, further research is crucial to guide specific interventions aimed at enhancing the well-being of this vulnerable population throughout their development.