Development of lung function in very low birth weight infants with or without bronchopulmonary dysplasia: Longitudinal assessment during the first 15 months of corrected age (original) (raw)
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Archives of Disease in Childhood, 1982
Twenty infants, mechanically ventilated in the neonatal period for respiratory distress syndrome, were compared with 15 healthy controls, matched for birthweight (less than 1501 g) but greater in mean gestational age. Clinical features and lung mechanics (by whole body plethysmography) were recorded at 6-monthly intervals until about one year. The neonatal course of the mechanically ventilated infants was commonly complicated by tracheobronchial hypersecretion and the later course by a fairly high incidence of lower respiratory tract illness. In this group, thoracic gas volume, dynamic compliance, pulmonary and airways conductance were all abnormal during the middle 4 months of the first year and reverted towards normal towards the end of the first year. The control group had normal lung mechanics. Early lung function tests were of limited value in predicting later lower respiratory tract illness, which was more common in boys, after neonatal mechanical ventilation for longer than 24 hours or raised ambient oxygen for longer than 5 days. There were few predictive physical signs. In this group of very low birthweight infants, respiratory distress syndrome of sufficient severity to require mechanical ventilation led to significant physiological and clinical disturbances of lung function which lasted into the second 6 months of life and which were particularly severe in those who had recurrent lower respiratory tract illness.
Pediatric Pulmonology, 1990
Pulmonary function was evaluated in both infancy and childhood in the same 19 prematurely born infants, who required mechanical ventilation (MV) during the neonatal period. Results of our patients were compared with those of control subjects. Upon first evaluation, we found that lung resistance (RL) was significantly elevated (24.85 f 6.06 vs. 17.77 2 2.39 cmH,O/L/s; P < 0.01). The mean value of dynamic lung compliance (CLdyn) was low, but the difference compared to controls did not reach significance. From infancy to childhood, elevated R, persisted (9.33 t-2.51 vs. 6.52 f 1.52 cm H,O/Us; P < 0.01), and the decrease of CLOY" became significant (46.86 f 12.84 vs. 59.34 * 15.68 mlfcmH,O; P < 0.05). In addition, maximum flow at functional residual capacity was significantly decreased (0.824 2 0.284 vs.
Journal of Perinatology, 2020
Objective To compare pulmonary function in extremely low birth weight (ELBW) infants with bronchopulmonary dysplasia (BPD) studied at 34-36 weeks postmenstrual age (PMA) with a reference group of "healthy" infants born at 34-36 weeks. We hypothesized that ELBW infants have decreased functional residual capacity (FRC) and respiratory compliance (Crs). Study design Pulmonary function testing was performed at 34-36 weeks PMA in infants with BPD and within 96 h of age in infants delivered at 34-36 weeks. Results Twenty BPD patients and 20 healthy infants were studied. FRC (18.9 versus 26.2 mL/kg; adjusted 95% CI 5.0, 10.9; P < 0.001) and Crs (0.80 versus 1.29-mL/cm H 2 O/kg; 95% CI 0.31, 0.71; P < 0.001) were decreased in BPD patients. Respiratory resistance was increased in BPD patients. Conclusions ELBW infants with BPD have decreased pulmonary function compared to healthy infants delivered at 34-36 weeks. This suggests that infants with BPD have smaller lung volumes.
Longitudinal assessment of lung function in extremely prematurely born children
Pediatric pulmonology, 2018
To assess longitudinally small airway function in children born extremely prematurely and whether there was a correlation between airway function in infancy and at 11-14 years. There would be tracking of airways obstruction and small airway function would deteriorate during childhood in those born extremely prematurely. A longitudinal study. Thirty-five children with a mean gestational age of 26 weeks had lung function assessed at 1 year corrected and 11-14 years of age. Lung volumes were measured by helium gas dilution (FRCHe ) and plethysmography (FRCpleth ) and small airway function assessed by calculating the FRCHe :FRCpleth ratio. Airway function was assessed at 1 year corrected by measurement of airway resistance (Raw ) and at 11-14 years by assessment of Raw , forced expiratory flow from 75% of vital capacity (FEF75 ), and forced expiratory volume at one second (FEV1 ). At the first assessment, the children had a mean (SD) FRCHe :FRCpleth of 0.90 (0.13) and at the second, 0.8...
Lung function abnormalities at 6 months of age after neonatal intensive care
Archives of Disease in Childhood, 1991
Respiratory function was studied in 46 preterm infants (median gestational age 28 weeks) at 6 months of age. Respiratory function was assessed by measurement of thoracic gas volume, airways resistance (from which specific conductance was calculated), and functional residual capacity. To determine the effect of the duration of neonatal intermittent positive pressure ventilation (IPPV) on respiratory function, the infants' results were divided into three groups: group A, no IPPV; group B, IPPV for less than seven days; and group C, IPPV for more than seven days. Measurements of thoracic gas volume and functional residual capacity were similar to published reference ranges and there were no significant differences between the three groups. Measurements of airways resistance and specific conductance were higher than published reference ranges (mean airways resistance of group A, 34 cm H20/l/sec; B, 34-1 cm H20/Ilsec, and C, 30*4 cm H20/l/sec) but there was no significant difference between the three groups. The 95% confidence intervals of the difference of the means between groups A and B were -6-94 to 6-73 cm H20/l/sec and between groups A and C -3-8 to 11-0 cm H20/l/sec. Our results suggest that factors other than neonatal ventilation may be more important in the pathogenesis of chronic lung function abnormalities in preterm infants.
Assessment of pulmonary function in resolving chronic lung disease of prematurity
Archives of Disease in Childhood - Fetal and Neonatal Edition, 1997
Aim-To investigate the longitudinal changes of interstitial and airways disease in resolving chronic lung disease of prematurity (CLD). Methods-Thirty three infants were studied between 35 and 40 weeks of postconceptional age, and then at three monthly intervals throughout their first year. Measurements of mean arterial oxygen saturation (MSaO 2 ) and its variability ( MSaO 2 ) were recorded. PaCO 2 and PaO 2 were determined while the infants breathed steady state 50% oxygen via a hood. From these, the alveolar arterial diVerence (A-a) Do 2 50 was calculated. Airway disease was assessed by the measurement of partial forced expiratory flow volume curves (PEFC) to give Ṽ max Frc. Results-The cohort mean +/-95% confidence intervals measured between 35 and 40 weeks were for MSaO 2 (89z25 +/-1z87%, range 75-96z5%) and MSaO 2 (4z79 +/-0z8%, range 0z16-9z64%), PaCO 2 (5z89 +/-0z56 kpa, range 4z2-10z11 kpa), (A-a) Do 2 50 (22z7 +/-2z56 kpa, range 6z67-31z4 kpa) and Ṽ max Frc (41z5 +/-8z65 mls/second, range 8z5-103z7 ml/second). The most significant improvement in all measurements occurred within the first three months (P = 0z05). An MSaO 2 of less than 90% in room air at 1 year of age was predicted between 35 and 40 weeks postconceptional age by an (A-a) Do 2 50 of greater than 29 kpa, with a sensitivity of 0z85 and a specificity of 0z88, and a PaCO 2 greater than 7 kpa predicted a specificity of 0z78 and a sensitivity of 0z88. Predictions were strengthened by combining the above criteria and these then gave a sensitivity and specificity of 1.
Evaluation of criteria for chronic lung disease in surviving very low birth weight infants
The Journal of Pediatrics, 1998
Criteria in common use for the diagnosis of chronic lung disease of prematurity or bronchopulmonary dysplasia in the neonatal period have not been sufficiently compared and validated against indicators of later respiratory complications. In this study of all 680 infants ≤1500 gm birth weight admitted to six perinatal centers August 1, 1988, to July 31, 1990 were alive and had no major congenital anomalies at 5 years old. Of 419 who had given permission to release their names and addresses, 272 were located and participated in a follow-up study. The following diagnostic criteria for bronchopulmonary dysplasia and chronic lung disease of prematurity were used during the initial hospitalization: (1) use of supplemental oxygen on day 30 of life, (2) a comprehensive bronchopulmonary dysplasia severity score applied at 25 to 35 days of life developed by a clinician panel to adjust for practice variation in ventilatory support and blood gases, (3) use of supplemental oxygen on day 30 of life with radiographic evidence consistent with bronchopulmonary dysplasia between days 25 and 35 of life, (4) radiographic evidence consistent with bronchopulmonary dysplasia alone, and (5) use of supplemental oxygen at 36 weeks' postconceptional age. These criteria were assessed against use of bronchodilators or steroids during the first 2 years of life, diagnosis of asthma, and hospitalizations for respiratory causes up to age 5. Although all criteria were significantly associated with all the outcomes, radiographic evidence was most predictive. These results indicate that, during a period when 21% of neonates were exposed to antenatal steroids, 24% received surfactant and 9% received postnatal corticosteroids, radiographic evidence was more predictive of long-term respiratory outcome than other commonly used criteria. (
Pulmonary function during the first year of life in healthy infants born prematurely
European Respiratory Journal, 1995
Premature birth is associated with increased respiratory morbidity. We investigated cross-sectionally, in 69 healthy infants who had never had cardiorespiratory problems, whether premature birth is associated with diminished pulmonary function. The study comprised 26 healthy infants born prematurely (PT), median gestational age 32 (26-36) weeks, and 43 healthy controls born full-term (FT), median gestational age 40 (37-42) weeks. Static respiratory system compliance (Crs) was assessed by weighted spirometry, combined with the measurement of the functional residual capacity by closed circuit helium dilution (FRCHe) and with assessment of ventilation distribution from the mixing index (MI). Repeatability of these indices was also assessed. Premature and full-term infants had the same length-corrected FRCHe; their Crs was different, but the difference disappeared when gestational age was taken into account. Mixing index was unrelated to body size and was not different between full-term and premature infants. Crown-heel length and lung volume were not different for any postconceptional age. However, infants born prematurely were smaller and had smaller lung volume at any postnatal age compared to those born at term. Repeatability of the indices was fair. These findings suggest that gestational age <37 weeks is associated with normal respiratory system mechanics for body size, and normal distribution of ventilation in healthy infants who never had cardiorespiratory problems.
Lung protective ventilatory strategies in very low birth weight infants
Journal of Perinatology, 2008
Respiratory distress syndrome (RDS) is the most common respiratory diagnosis in preterm infants. Surfactant therapy and mechanical ventilation using conventional or high-frequency ventilation have been the standard of care in the management of RDS. Bronchopulmonary dysplasia (BPD) continues to remain as a major morbidity in very low birth weight infants despite these treatments. There is no significant difference in pulmonary outcome when an optimal lung volume strategy is used with conventional or high-frequency ventilation. Lung injury is directly related to the duration of invasive ventilation via the endotracheal tube. Studies using noninvasive ventilation, such as nasal continuous positive airway pressure and noninvasive positive pressure ventilation, have shown to decrease postextubation failures as well as a trend toward reduced risk of BPD. Lung protective ventilatory strategy may involve noninvasive ventilation as a primary therapy or following surfactant administration in very preterm infants with RDS. Initial steps in the management of preterm infants may also include sustained inflation to establish functional residual capacity, followed by noninvasive ventilation to minimize lung injury and subsequent development of BPD.
Pediatric Research, 1991
We assessed pulmonary function in 14 mechanically ventilated newborn very low birth weight infants with idiopathic respiratory distress syndrome by means of a face-out, volume displacement body plethysmograph and nitrogen washout analyses. Specially designed computer programs were used for calculations of lung volumes, ventilation, gas mixing efficiency, and mechanical parameters. In addition to very low compliance and moderately elevated resistance of the respiratory system, there were considerably impaired gas mixing efficiency and low functional residual capacity (FRC). No correlations between positive end-expiratory pressure and mean airway pressure versrrs compliance, resistance, or FRC could be found. Neither could correlations be found between FRC and compliance or FRC and the calculated right to left shunt. (Pediatr Res 30: 496-500,1991) Abbreviations Fi02, fraction of inspired oxygen FRC, functional residual capacity IRDS, idiopathic respiratory distress syndrome MAP, mean airway pressure NC, nitrogen clearance Pao*, arterial oxygen tension PIP, peak inspiratory pressure For methodologic reasons, lung function studies in newborn infants with IRDS have largely been focused on lung mechanics. Using applied methods makes it possible to obtain a more comprehensive picture of ventilatory conditions, even in very premature, severely affected infants. To further clarify the pathophysiology of IRDS under conditions of mechanical ventilation in this group of infants, we assessed lung volume, alveolar ventilation, gas mixing efficiency, and lung mechanics in mechanically ventilated infants with birth weights below 1500 g. MATERIALS AND METHODS We studied 14 very low birth weight infants with IRDS during intermittent positive pressure ventilation within 5 d (range 0-5 d) of birth. Six of the infants were boys and eight were girls. Median birth weight was 1.29 kg (range 1.00-1.50 kg) and