Respiratory Sequelae of Prematurity in School-Age Children: Is Bronchopulmonary Dysplasia Still the Primary Risk Factor?

<b>Background/Objectives</b>: Respiratory morbidity in preterm infants has been widely studied, with evidence showing that individuals born prematurely experience more frequent respiratory symptoms, airflow obstruction, and radiological lung abnormalities throughout life. <b>Methods</b>: This study included 150 children aged 6 to 11 years, divided into two groups. The preterm group (<i>n</i> = 90) consisted of children born before 32 weeks of gestation, while the control group (<i>n</i> = 60) included term-born children. All participants underwent spirometry and completed a respiratory health questionnaire. <b>Results</b>: A significantly higher proportion of preterm children exhibited respiratory morbidity compared to term-born peers (χ² = 7.035; <i>p</i> = 0.030). However, no significant differences were found between preterm children with and without bronchopulmonary dysplasia (BPD) defined at day 28 (BPD28) (χ² = 0.002; <i>p</i> = 0.968) or BPD defined at 36 weeks postmenstrual age (BPD36) (χ² = 0.029; <i>p</i> = 0.864). Lung function parameters-forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁), FEV₁/IVC, maximal expiratory flow at 25%, 50% and 75% of FVC (MEF₂₅, MEF₅₀, and MEF₇₅) were significantly lower in the preterm group (<i>p</i> = 0.004 for FVC and <i>p</i> < 0.001 for all other parameters). No significant differences were observed between BPD and non-BPD subgroups in any lung function parameter. BPD36 was found to be a stronger predictor of respiratory morbidity (OR = 1.214) than BPD28 (OR = 1.093), although neither BPD28 nor BPD36 were statistically significant predictors. <b>Conclusions</b>: This study underscores the long-term respiratory consequences of prematurity and challenges the traditional view of BPD as the primary determinant of poor respiratory outcomes. Our findings suggest that prematurity itself, rather than BPD, may play a more central role.