Why Some Children Born Too Early Have Weaker Lungs—And What Parents Should Know

Your Child's Early Birth May Affect Their Lungs Later

If your child was born very premature—before 32 weeks or weighing under 1.5 kg—you've probably spent sleepless nights worrying about their health. New research from Frontiers in Pediatrics gives us important insight into one area many parents overlook: lung development. The study followed over 100 children born very early and found that some still had breathing challenges years later, at preschool age.

What the Research Discovered

Researchers tested the lung function of 93 children (average age 5 years) who had been born very prematurely. Using a simple breathing test called spirometry, they measured how much air the children's lungs could hold and how quickly they could breathe out. The findings were striking: about 31% of these children showed abnormal lung function—meaning their lungs weren't working as efficiently as they should.

Even more interesting, the children with weaker lungs showed a strong response to bronchodilators (medications that help open airways). This suggests their airways are more reactive and prone to tightening—similar to what happens in asthma.

Which Children Face Greater Risk?

Not all premature babies develop lung problems. The study identified several warning signs that predict which children are more likely to have lasting lung weakness:

• Longer time on breathing machines: Children who needed mechanical ventilation (breathing support) for extended periods showed worse lung function.
• Steroid medications in hospital: Some premature infants receive glucocorticoids to help lung development, but interestingly, those who received them were more likely to have ongoing issues.
• Family history of allergies: If allergies or asthma run in your family, your premature child is at higher risk.
• Repeated respiratory infections: Children who caught colds, bronchitis, or other chest infections frequently showed poorer lung function.

What This Means for Singapore and Asian Families

In Singapore and across Asia, neonatal intensive care has improved dramatically, meaning more extremely premature babies survive. This research reminds us that survival is just the beginning—these children often need careful monitoring through early childhood. Many Singapore families may not realise their 5-year-old's frequent coughs or need for asthma puffers could be connected to their premature birth years ago.

This is especially important in our tropical climate, where respiratory infections are common, and where families may have limited awareness of long-term prematurity effects. The good news: having a baseline understanding of your child's lung health now means doctors can step in earlier if problems develop.

Three Steps Parents Can Take Now

1. Know Your Child's Prematurity History: If your child was born before 32 weeks or under 1.5 kg, keep detailed records of their hospital treatments—especially how long they needed breathing support and which medications they received. Share this with your paediatrician at every visit.
2. Watch for Respiratory Red Flags: Don't dismiss frequent coughing, wheezing, or shortness of breath as "just a phase." If your child catches chest infections more often than peers, or seems to tire easily with activity, mention it specifically to your doctor. Ask whether a lung function test (spirometry) would be helpful.
3. Minimise Infection Risk: Since repeated respiratory infections significantly worsen lung outcomes, keep your child's environment smoke-free, ensure they're up to date with vaccinations (including flu and pneumococcal), practice good hand hygiene, and avoid crowded spaces during peak illness seasons when possible.

Your child's premature start in life doesn't define their future—but being informed and proactive absolutely helps shape it.