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Walicka-Serzysko K, Postek M, Borawska-Kowalczyk U, Szamotulska K, Kwaśniewicz P, Polak K, Mierzejewska E, Sands D, Rutkowska M. Long-term pulmonary outcomes of young adults born prematurely: a Polish prospective cohort study PREMATURITAS 20. BMC Pulm Med 2024; 24:126. [PMID: 38475760 PMCID: PMC10935939 DOI: 10.1186/s12890-024-02939-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The long-term consequences of prematurity are often not sufficiently recognized. To address this gap, a prospective cohort study, which is a continuation of the multicenter Polish study PREMATURITAS, was conducted, utilizing unique clinical data from 20 years ago. OBJECTIVE The main goal was to evaluate lung function, detect any structural abnormalities using lung ultrasound, and assess psychological well-being in young adults born between 24 and 34 weeks of gestational age (GA). Additionally, the study aimed to investigate potential associations between perinatal risk factors and abnormalities observed in pulmonary function tests (PFTs) during adulthood. METHODS The young survivors underwent a comprehensive set of PFTs, a lung ultrasound, along with the quality of life assessment. Information regarding the neonatal period and respiratory complications was obtained from the baseline data collected in the PREMATURITAS study. RESULTS A total of 52 young adults, with a mean age of 21.6 years, underwent PFTs. They were divided into two groups based on GA: 24-28 weeks (n = 12) and 29-34 weeks (n = 40). The subgroup born more prematurely had significantly higher lung clearance index (LCI), compared to the other subgroup (p = 0.013). LCI ≥ 6.99 was more frequently observed in the more premature group (50% vs. 12.5%, p = 0.005), those who did not receive prenatal steroids (p = 0.020), with a diagnosis of Respiratory Distress Syndrome (p = 0.034), those who received surfactant (p = 0.026), and mechanically ventilated ≥ 7 days (p = 0.005). Additionally, elevated LCI was associated with the diagnosis of asthma (p = 0.010). CONCLUSIONS The findings suggest pulmonary effects due to prematurity persist into adulthood and their insult on small airway function. Regular follow-up evaluations of young survivors born preterm should include assessments of PFTs. Specifically, the use of LCI can provide valuable insights into long-term pulmonary impairment.
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Affiliation(s)
- Katarzyna Walicka-Serzysko
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland.
- Cystic Fibrosis Centre, Pediatric Hospital, Dziekanów Leśny, Poland.
| | - Magdalena Postek
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland
- Cystic Fibrosis Centre, Pediatric Hospital, Dziekanów Leśny, Poland
| | - Urszula Borawska-Kowalczyk
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland
- Cystic Fibrosis Centre, Pediatric Hospital, Dziekanów Leśny, Poland
| | - Katarzyna Szamotulska
- Department of Epidemiology and Biostatistics, Institute of Mother and Child, Warsaw, Poland
| | - Piotr Kwaśniewicz
- Diagnostic Imaging Department, Institute of Mother and Child, Warsaw, Poland
| | - Krystyna Polak
- Neonatology Clinic, Institute of Mother and Child, Warsaw, Poland
| | - Ewa Mierzejewska
- Department of Epidemiology and Biostatistics, Institute of Mother and Child, Warsaw, Poland
| | - Dorota Sands
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland
- Cystic Fibrosis Centre, Pediatric Hospital, Dziekanów Leśny, Poland
| | - Magdalena Rutkowska
- Department of Epidemiology and Biostatistics, Institute of Mother and Child, Warsaw, Poland
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Danan C, Tauzin M, Jung C, Carbonnier B, Dassieu G, Decobert F, Caeymaex L. Instrumental dead space: A glass ceiling for extremely low birth weight preterm infants? A dead space washout bench study. Pediatr Pulmonol 2023; 58:1514-1519. [PMID: 36785523 DOI: 10.1002/ppul.26353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/22/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND When ventilating extremely low birth weight infants, clinicians face the problem of instrumental dead space, which is often larger than tidal volume. Hence, aggressive ventilation is necessary to achieve CO2 removal. Continuous tracheal gas insufflation can wash out CO2 from dead space and might also have an impact on O2 and water vapor transport. The objective of this bench study is to test the impact of instrumental dead space on the transport of CO2 , O2 , and water vapor and the ability of continuous tracheal gas insufflation to remedy this problem during small tidal volume ventilation. METHODS A test-lung located in an incubator at 37°C was ventilated with pressure levels needed to reach different tidal volumes from 1.5 to 5 mL. End-tidal CO2 at the test-lung exit, O2 concentration, and relative humidity in the test-lung were measured for each tidal volume with and without a 0.2 L/min continuous tracheal gas insufflation flow. RESULTS CO2 clearance was improved by continuous tracheal gas insufflation allowing a 28%-44% of tidal volume reduction. With continuous tracheal gas insufflation, time to reach desired O2 concentration was reduced from 20% to 80% and relative humidity was restored. These results are inversely related to tidal volume and are particularly critical below 3 mL. CONCLUSION For the smallest tidal volumes, reduction of instrumental dead space seems mandatory for CO2 , O2 , and water vapor transfer. Continuous tracheal gas insufflation improved CO2 clearance, time to reach desired O2 concentration and humidification of airways and, thus, may be an option to protect lung development.
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Affiliation(s)
- Claude Danan
- Neonatal Intensive Care Unit, CHI Créteil, Créteil, France.,INSERM CNRS ERL 7000, IMRB, Université Paris Est Creteil, Créteil, France
| | - Manon Tauzin
- Neonatal Intensive Care Unit, CHI Créteil, Créteil, France
| | - Camille Jung
- Clinical Research Centre, Centre Hospitalier Intercommunal de Créteil, Créteil, France.,Pediatrics, Centre Hospitalier Intercommunal de Creteil, Créteil, France
| | | | - Gilles Dassieu
- Neonatal Intensive Care Unit, CHI Créteil, Créteil, France.,INSERM CNRS ERL 7000, IMRB, Université Paris Est Creteil, Créteil, France
| | - Fabrice Decobert
- Neonatal Intensive Care Unit, CHI Créteil, Créteil, France.,INSERM CNRS ERL 7000, IMRB, Université Paris Est Creteil, Créteil, France
| | - Laurence Caeymaex
- Neonatal Intensive Care Unit, CHI Créteil, Créteil, France.,Faculté de Santé, University Paris Est Creteil, Créteil, Val de Marne, France
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Amitai N, Stafler P, Blau H, Kaplan E, Mussaffi H, Levine H, Steuer G, Bar-Yishay E, Klinger G, Mei-Zahav M, Prais D. Palivizumab Following Extremely Premature Birth Does Not Affect Pulmonary Outcomes in Adolescence. Chest 2020; 158:660-669. [PMID: 32298728 DOI: 10.1016/j.chest.2020.02.075] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Prematurity is a risk factor for impaired lung function. We sought to assess the long-term effect of palivizumab immunization and extreme prematurity (<29 weeks gestation) on respiratory symptoms and pulmonary function in adolescence. RESEARCH QUESTION What is the long-term effect of palivizumab immunization and extreme prematurity (<29 weeks) on respiratory symptoms and pulmonary function in adolescence? STUDY DESIGN AND METHODS We examined survivors of extreme prematurity (<29 weeks gestation) at 13 to 18 years of age (study group). Study group babies who were born immediately before palivizumab immunization (nonpalivizumab group [NPG]) were compared with those babies who were born just after implementation (PG) and with a control group. For study group patients, lung function in adolescence was further compared longitudinally with that at primary school age. RESULTS Sixty-four adolescents aged 15.76 ± 1.52 years were included: 46 in the study group (17 PG and 29 NPG) and 18 in the control group. For the study group, wheezing episodes, inhaler use, and hospitalizations were uncommon. For the study group compared with the control group, FEV1 percent predicted was 82.60% ± 13.54% vs 105.83% ± 13.12% (P < .001), and the lung clearance index was 7.67 ± 1.02 vs 7.46 ± 0.70 (P = .48), respectively. Study group adolescents with bronchopulmonary dysplasia had a higher lung clearance index than did adolescents with no bronchopulmonary dysplasia (7.94 ± 1.11 vs 7.20 ± 0.60; P = .002). PG and NPG adolescents were not significantly different. Comparing the study group in adolescence with primary school age, we found improvement in mean FEV1 percent predicted bronchodilator response (0.37% ± 9.98% vs 5.67% ± 9.87%; P = .036) and mean provocative concentration causing 20% decline in FEV1 (12.16 ± 4.71 mg/mL vs 4.14 ± 4.51 mg/mL, respectively; P < .001). INTERPRETATION Palivizumab did not provide any discernable long-term protective effect. Nevertheless, adolescent survivors of extreme prematurity showed good clinical and physiologic outcomes, except for mildly raised lung clearance index in patients with bronchopulmonary dysplasia. Airway hyperreactivity detected at primary school age, decreased by adolescence.
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Affiliation(s)
- Nofar Amitai
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva
| | - Patrick Stafler
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Hannah Blau
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Eytan Kaplan
- Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Huda Mussaffi
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Hagit Levine
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Guy Steuer
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva
| | - Ephraim Bar-Yishay
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Gil Klinger
- Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Meir Mei-Zahav
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Dario Prais
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv.
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Kim YH, Kim KW, Eun HS, Shin JE, Sol IS, Kim SY, Kim YS, Sohn MH, Namgung R. Small for gestational age birth may increase airflow limitation in bronchopulmonary dysplasia. Pediatr Pulmonol 2020; 55:346-353. [PMID: 31794162 DOI: 10.1002/ppul.24580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 11/10/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To determine significant indices for assessing the pulmonary function of infants according to bronchopulmonary dysplasia (BPD) severity and to evaluate whether small for gestational age (SGA) could affect pulmonary function in BPD. METHODS We evaluated 117 preterm infants who had undergone tidal breathing flow-volume loop and multiple-breath washout analyses within 7 months after birth. We categorized preterm infants according to BPD severity into mild/moderate BPD (n = 86), severe BPD (n = 21), and without BPD (n = 10) and the presence of SGA or appropriate gestational age (AGA) using the Fenton growth chart. We evaluated nine healthy term infants as controls. RESULTS The tidal breathing ratio (time to peak expiratory flow/expiratory time [tPEF /tE ]) was significantly lower in infants with severe BPD than in those with mild/moderate BPD. Lung clearance index (LCI) was not different based on BPD severity. In the correlation analysis after adjusting for gestational age and sex, tPEF /tE was correlated with the duration of mechanical ventilation (r = -0.347, P < .001) and the duration of oxygen supply (r = -0.248, P = .013) in infants with BPD. The proportion of "lower tPEF /tE ," defined as below the cut-off value, was greater in SGA infants (P = .017), while no significant difference was seen in the percentage of "higher LCI," defined as above the cut-off value between SGA and AGA infants. CONCLUSIONS In infants with BPD, tPEF /tE could be a useful pulmonary index which shows lower values in severe BPD. The finding of SGA in infants with BPD could be associated with poor pulmonary function related to the tPEF /tE values.
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Affiliation(s)
- Yoon Hee Kim
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Sun Eun
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Division of Neonatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Eun Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Division of Neonatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - In Suk Sol
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Yeon Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Suh Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ran Namgung
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Division of Neonatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Motta-Ribeiro GC, Jandre FC, Wrigge H, Giannella-Neto A. Generalized estimation of the ventilatory distribution from the multiple-breath washout: a bench evaluation study. Biomed Eng Online 2018; 17:3. [PMID: 29335011 PMCID: PMC5769492 DOI: 10.1186/s12938-018-0442-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 01/11/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The multiple-breath washout (MBW) is able to provide information about the distribution of ventilation-to-volume (v/V) ratios in the lungs. However, the classical, all-parallel model may return skewed results due to the mixing effect of a common dead space. The aim of this work is to examine whether a novel mathematical model and algorithm is able to estimate v/V of a physical model, and to compare its results with those of the classical model. The novel model takes into account a dead space in series with the parallel ventilated compartments, allows for variable tidal volume (VT) and end-expiratory lung volume (EELV), and does not require a ideal step change of the inert gas concentration. METHODS Two physical models with preset v/V units and a common series dead space (vd) were built and mechanically ventilated. The models underwent MBW with N2 as inert gas, throughout which flow and N2 concentration signals were acquired. Distribution of v/V was estimated-via nonnegative least squares, with Tikhonov regularization-with the classical, all-parallel model (with and without correction for non-ideal inspiratory N2 step) and with the new, generalized model including breath-by-breath vd estimates given by the Fowler method (with and without constrained VT and EELV). RESULTS The v/V distributions estimated with constrained EELV and VT by the generalized model were practically coincident with the actual v/V distribution for both physical models. The v/V distributions calculated with the classical model were shifted leftwards and broader as compared to the reference. CONCLUSIONS The proposed model and algorithm provided better estimates of v/V than the classical model, particularly with constrained VT and EELV.
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Affiliation(s)
- Gabriel Casulari Motta-Ribeiro
- Pulmonary Engineering Laboratory, Biomedical Engineering Programme, COPPE, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Frederico Caetano Jandre
- Pulmonary Engineering Laboratory, Biomedical Engineering Programme, COPPE, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Hermann Wrigge
- Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany
| | - Antonio Giannella-Neto
- Pulmonary Engineering Laboratory, Biomedical Engineering Programme, COPPE, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany
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Dassios T, Kaltsogianni O, Greenough A. Determinants of pulmonary dead space in ventilated newborn infants. Early Hum Dev 2017; 108:29-32. [PMID: 28371672 DOI: 10.1016/j.earlhumdev.2017.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/17/2017] [Accepted: 03/19/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pulmonary dead space (VD) is an index of ventilation inhomogeneity and one of the determinants of the magnitude of tidal volume to maintain optimal blood gases. AIMS To identify the determinants of VD in ventilated newborns and to investigate differences in VD between prematurely born and term infants and those prematurely born infants who did or did not develop bronchopulmonary dysplasia (BPD). METHODS Sixty-one mechanically ventilated infants (15 term, 46 preterm) were studied at a median age of 8 (IQR 2-31) days; 32 of the preterm infants developed BPD. VD was determined from the difference between arterial and end tidal carbon dioxide (CO2) using a low dead space CO2 detector using the Bohr/Enghoff equation and was related to body weight (VD/kg) at the time of study. The time to peak tidal expiratory flow/expiratory time (TPTEF/TE) was measured during spontaneous breathing using a fixed orifice pneumotachograph. RESULTS VD/kg was related to gestational age (r=-0.285, p=0.001), birth weight (r=-0.356, p<0.001), weight (r=-0.316, p<0.001) and postmenstrual age (r=-0.205, p=0.020) at measurement, days of ventilation (r=0.322, p<0.001) and TPTEF/TE (r=-0.397, p=0.003). The median VD/kg was higher in prematurely born infants [2.3 (IQR: 1.7-3.0) ml/kg] compared to term infants [1.5 (1.3-2.1) ml/kg, (p=0.003)] and in premature infants that developed BPD [2.6 (IQR 1.8-3.4) ml/kg] compared to those who did not [1.7 (IQR 1.1-1.9) ml/kg], (p<0.001). CONCLUSIONS Numerous factors influence pulmonary dead space and thus an optimum tidal volume will differ according to the underlying demographics and respiratory status.
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Affiliation(s)
- Theodore Dassios
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK.
| | - Ourania Kaltsogianni
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Anne Greenough
- Division of Asthma, Allergy and Lung Biology, MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, UK; National Institute for Health Research (NIHR), Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, King's College London, UK
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