One of the most addictive and harmful drugs of all is perfectly legal. Tobacco, and the nicotine it contains, are subject to prohibition for adults nowhere in the world, despite millions of deaths, prolonged severe disability, and being probably as addictive as cocaine or heroin. We have long thought that the lung injury that preterm babies experience will probably lead to worse outcomes in adulthood, with a chance of increased COPD, this study tests that belief. (Bui DS, et al. Association between very to moderate preterm births, lung function deficits, and COPD at age 53 years: analysis of a prospective cohort study. The Lancet Respiratory Medicine. 2022). In fact, overall, the results from this study of follow up at 53 years of age are quite encouraging. Although there were very few of the very preterm babies, 28 to <32 weeks, (there weren’t many survivors less than 32 weeks in 1961) when added with the moderate preterm, 32 to <34 weeks they had a cohort of 46 babies to compare with over 1400 full term infants, and 172 late preterms.
The post-bronchodilator forced expiratory flows were a bit lower in the very to moderately preterm-born subjects, but only among those who also smoked. The non-smokers look identical between the preterm and the term born subjects.
Our current NICU survivors, who often have chronic lung disease, will probably have a very different profile in their long term than the babies in this study, we can imagine the potentially horrific effects of cigarette smoke on their pulmonary function in late adulthood.
Assuring good long-term health of former preterms looks like it will be critically dependent on finding ways to stop them smoking. Perhaps the proposed ban in New Zealand, which, starting in 2027 will make it illegal to supply cigarettes to anyone born after 2008, is the way to go. I think we should probably start sooner than that, and, as we know that parental smoking is a strong predictor of whether their children start smoking, stopping-smoking interventions for parents of preterms should be a priority.