Childhood interstitial lung disease: short lessons from telomeres.

### Learning points A 16-year-old boy with persisting fixed obstructive spirometry is approaching transition to adult services. He has been under long-term follow-up, initially referred aged 2 months by his local team for tachypnoea and mild respiratory distress since birth. He was born at term by vaginal delivery with meconium suctioned from his oropharynx and admitted to a special care baby unit for observation and intravenous antibiotics. Chest X-ray (CXR) at birth was reportedly consistent with possible meconium aspiration, although there was no neonatal resuscitation or ventilation required and he was discharged home after 4 days without an oxygen requirement. Flexible bronchoscopy was arranged that was unremarkable, there was no evidence of aspiration or infection, he had a negative congenital infection screen and normal echocardiogram. CT chest showed linear atelectasis, occasional thickened interlobular septa and areas of secondary pulmonary lobular hyperinflation. Neither bronchopulmonary dysplasia (BPD) nor meconium aspiration syndrome really fits his neonatal history or imaging appearance. He was well in himself and so was discharged with a plan for regular outpatient review. Follow-up CT chest age 3 years (figure 1A) demonstrated persistent abnormality with an …