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Vijverberg SJH, Kampouras A, Nayir Büyükşahin H, Makrinioti H, Petrarca L, Schmidt M, Schreck LD, Urbantat RM, Beydon N, Goutaki M, Lavizzari A, Proesmans M, Schramm D, Stahl M, Zacharasiewicz A, Moeller A, Pijnenburg MW. ERS International Congress 2023: highlights from the Paediatrics Assembly. ERJ Open Res 2024; 10:00853-2023. [PMID: 38410713 PMCID: PMC10895434 DOI: 10.1183/23120541.00853-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 02/28/2024] Open
Abstract
Respiratory health in children is essential for general wellbeing and healthy development in the short and long term. It is well known that many respiratory diseases in adulthood have their origins in early life, and therefore research on prevention of respiratory diseases and management of children with respiratory diseases will benefit patients during the full life course. Scientific and clinical advances in the field of respiratory health are moving at a fast pace. This article summarises some of the highlights in paediatric respiratory medicine presented at the hybrid European Respiratory Society (ERS) International Congress 2023 which took place in Milan (Italy). Selected sessions are summarised by Early Career Members of the Paediatrics Assembly (Assembly 7) under the supervision of senior ERS officers, and cover a wide range of research areas in children, including respiratory physiology and sleep, asthma and allergy, cystic fibrosis, respiratory infection and immunology, neonatology and intensive care, respiratory epidemiology and bronchology.
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Affiliation(s)
- Susanne J H Vijverberg
- Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Pediatric Pulmonology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Asterios Kampouras
- Paediatric Pulmonology Department, 424 General Military Hospital, Thessaloniki, Greece
| | - Halime Nayir Büyükşahin
- Division of Pulmonology, Department of Paediatrics, Mardin Training and Research Hospital, Mardin, Turkey
| | - Heidi Makrinioti
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Laura Petrarca
- Translational and Precision Medicine Department, "Sapienza" University of Rome, Rome, Italy
- Maternal Infantile and Urological Sciences Department, "Sapienza" University of Rome, Rome, Italy
| | - Mehtap Schmidt
- Department of Pediatrics, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Vienna, Austria
| | - Leonie D Schreck
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Ruth M Urbantat
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Lung Research (DZL), associated partner site, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nicole Beydon
- Assistance Publique-Hôpitaux de Paris, Unité Fonctionnelle de Physiologie - Explorations Fonctionnelles Respiratoires et du Sommeil, Hôpital Armand Trousseau, Paris, France
- INSERM, U 938, Centre de Recherche Saint Antoine, Hôpital Saint-Antoine, Paris, France
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna Lavizzari
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marijke Proesmans
- Division of Woman and Child, Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Schramm
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Mirjam Stahl
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Lung Research (DZL), associated partner site, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Angela Zacharasiewicz
- Department of Pediatrics, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Vienna, Austria
| | - Alexander Moeller
- Department of Paediatric Pulmonology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marielle W Pijnenburg
- Department of Paediatrics, Division of Paediatric Respiratory Medicine and Allergology, Erasmus MC - Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands
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De Luca D, Loi B, Tingay D, Fiori H, Kingma P, Dellacà R, Autilio C. Surfactant status assessment and personalized therapy for surfactant deficiency or dysfunction. Semin Fetal Neonatal Med 2023; 28:101494. [PMID: 38016825 DOI: 10.1016/j.siny.2023.101494] [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] [Indexed: 11/30/2023]
Abstract
Surfactant is a pivotal neonatal drug used both for respiratory distress syndrome due to surfactant deficiency and for more complex surfactant dysfunctions (such as in case of neonatal acute respiratory distress syndrome). Despite its importance, indications for surfactant therapy are often based on oversimplified criteria. Lung biology and modern monitoring provide several diagnostic tools to assess the patient surfactant status and they can be used for a personalized surfactant therapy. This is desirable to improve the efficacy of surfactant treatment and reduce associated costs and side effects. In this review we will discuss these diagnostic tools from a pathophysiological and multi-disciplinary perspective, focusing on the quantitative or qualitative surfactant assays, lung mechanics or aeration measurements, and gas exchange metrics. Their biological and technical characteristics are described with practical information for clinicians. Finally, available evidence-based data are reviewed, and the diagnostic accuracy of the different tools is compared. Lung ultrasound seems the most suitable tool for assessing the surfactant status, while some other promising tests require further research and/or development.
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Affiliation(s)
- Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Paris, France; Physiopathology and Therapeutic Innovation Unit, INSERM U999, Paris Saclay University, Paris, France; Department of Pediatrics, Division of Neonatology, Stanford University, School of Medicine - Lucile Packard Children's Hospital, Palo Alto, CA, USA.
| | - Barbara Loi
- Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Paris, France; Physiopathology and Therapeutic Innovation Unit, INSERM U999, Paris Saclay University, Paris, France
| | - David Tingay
- Neonatal Research Unit, Murdoch Children's Research Institute, Parkville, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Humberto Fiori
- Division of Neonatology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Paul Kingma
- Perinatal Institute, Cincinnati Children's University Hospital Medical Center, Cincinnati, OH, USA
| | - Raffaele Dellacà
- Department of Electronics, Information and Bio-engineering, Polytechnical University of Milan, Milan, Italy
| | - Chiara Autilio
- Department of Biochemistry and Molecular Biology and Research Institute Hospital October 12 (imas12), Faculty of Biology, Complutense University, Madrid, Spain; Clinical Pathology and Microbiology Unit, San Carlo Hospital, Potenza, Italy
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Lavizzari A, Esposito B, Pesenti N, Shaykhova A, Vizzari G, Ophorst M, Gangi S, Morniroli D, Colnaghi M, Mosca F, Giannì ML. Dose-dependent impact of human milk feeding on tidal breathing flow-volume loop parameters across the first 2 years of life in extremely low-birth-weight infants: a cohort study. Eur J Pediatr 2023; 182:4969-4976. [PMID: 37610435 DOI: 10.1007/s00431-023-05163-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/24/2023]
Abstract
The purpose of this study is to test the hypothesis that higher consumption of human milk (HM) in preterm infants with birth weight (BW) <1000 g is associated with improved lung function in a dose-dependent manner over the first 2 years of corrected age (CA). This retrospective study at an academic medical center included infants with BW <1000g. They had lung function assessment by the tidal breathing flow-volume loop (TBFVL) follow-up visits at 0-3-, 3-6-, 6-12-, 12-18-, and 18-24-month CA. One hundred eighty infants were included in the study with a mean (SD) gestational age 26.5 (1.90) weeks and BW 772.4 (147.0) g, 50% were female, and 60% developed BPD. 62.8% of infants received HM during the NICU stay. According to a general linear model (including GA, being small for GA (SGA), sex, human milk percentage, sepsis, and BPD), on average, each week of GA resulted in a higher tPTEF/tE of 1.24 (p = 0.039) and being SGA in a lower tPTEF/tE of 5.75 (p = 0.013) at 0-3-month CA. A higher percentage of human milk out of the total enteral intake was associated with better tPTEF/tE z-scores at 0-3 months (p = 0.004) and 18-24 months of CA (p = 0.041). BPD diagnosis was associated with a relevantly worse tPTEF/tE z-score at 6-12 months of CA (p = 0.003). CONCLUSION Preterm infants with higher consumption of HM had significantly less airway obstruction across the first 2 years, suggesting that human milk may contribute in a dose-dependent manner to improve lung function in early childhood in former preterm infants born ELBW. WHAT IS KNOWN • Human milk feeding reduces the risk of prematurity-related morbidities, including necrotizing enterocolitis, sepsis, lower respiratory tract infections, and BPD. Both exclusive and partial human milk feeding appear to be associated with a lower risk of BPD in preterm infants. WHAT IS NEW • This cohort study of 180 preterm infants with birth weight < 1000 g found that exposure to human milk during hospitalization improves airway obstruction markers tPTEF/tE z-score over the first 2 years of corrected age in a dose-dependent manner.
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Affiliation(s)
- Anna Lavizzari
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122, Milan, Italy.
| | - Benedetta Esposito
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Nicola Pesenti
- Revelo Datalabs Srl, Via Spezia 1, 20142, Milan, Italy
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milan-Bicocca, Milan, Italy
| | - Alina Shaykhova
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giulia Vizzari
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122, Milan, Italy
| | - Marijke Ophorst
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122, Milan, Italy
| | - Silvana Gangi
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122, Milan, Italy
| | - Daniela Morniroli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Mariarosa Colnaghi
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maria L Giannì
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Balázs G, Balajthy A, Seri I, Hegyi T, Ertl T, Szabó T, Röszer T, Papp Á, Balla J, Gáll T, Balla G. Prevention of Chronic Morbidities in Extremely Premature Newborns with LISA-nCPAP Respiratory Therapy and Adjuvant Perinatal Strategies. Antioxidants (Basel) 2023; 12:1149. [PMID: 37371878 DOI: 10.3390/antiox12061149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Less invasive surfactant administration techniques, together with nasal continuous airway pressure (LISA-nCPAP) ventilation, an emerging noninvasive ventilation (NIV) technique in neonatology, are gaining more significance, even in extremely premature newborns (ELBW), under 27 weeks of gestational age. In this review, studies on LISA-nCPAP are compiled with an emphasis on short- and long-term morbidities associated with prematurity. Several perinatal preventative and therapeutic investigations are also discussed in order to start integrated therapies as numerous organ-saving techniques in addition to lung-protective ventilations. Two thirds of immature newborns can start their lives on NIV, and one third of them never need mechanical ventilation. With adjuvant intervention, these ratios are expected to be increased, resulting in better outcomes. Optimized cardiopulmonary transition, especially physiologic cord clamping, could have an additively beneficial effect on patient outcomes gained from NIV. Organ development and angiogenesis are strictly linked not only in the immature lung and retina, but also possibly in the kidney, and optimized interventions using angiogenic growth factors could lead to better morbidity-free survival. Corticosteroids, caffeine, insulin, thyroid hormones, antioxidants, N-acetylcysteine, and, moreover, the immunomodulatory components of mother's milk are also discussed as adjuvant treatments, since immature newborns deserve more complex neonatal interventions.
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Affiliation(s)
- Gergely Balázs
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - András Balajthy
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - István Seri
- First Department of Pediatrics, School of Medicine, Semmelweis University, 1083 Budapest, Hungary
- Keck School of Medicine of USC, Children's Hospital of Los Angeles, Los Angeles, CA 90033, USA
| | - Thomas Hegyi
- Department of Pediatrics, Division of Neonatology, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ 08903, USA
| | - Tibor Ertl
- Departments of Neonatology and Obstetrics & Gynecology, University of Pécs Medical School, 7624 Pécs, Hungary
- MTA-PTE Human Reproduction Scientific Research Group, University of Pécs, 7624 Pécs, Hungary
| | - Tamás Szabó
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Tamás Röszer
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Ágnes Papp
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - József Balla
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
- ELKH-UD Vascular Pathophysiology Research Group, Hungarian Academy of Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | - Tamás Gáll
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - György Balla
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
- ELKH-UD Vascular Pathophysiology Research Group, Hungarian Academy of Sciences, University of Debrecen, 4032 Debrecen, Hungary
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Ardura-Garcia C, Kainz K, Mallet MC, Petrarca L, Rodman Berlot J, Slaats M, Streibel C, Vijverberg S, Williams EE, Goutaki M, Gray DM, Lavizzari A, Morty RE, Proesmans M, Schramm D, Stahl M, Zacharasiewicz A, Moeller A, Pijnenburg MW. ERS International Congress 2022: highlights from the Paediatrics Assembly. ERJ Open Res 2023; 9:00653-2022. [PMID: 37228264 PMCID: PMC10204827 DOI: 10.1183/23120541.00653-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/02/2023] [Indexed: 03/11/2023] Open
Abstract
This review has been prepared by the Early Career Members and Chairs of the European Respiratory Society (ERS) Assembly 7: Paediatrics. We here summarise the highlights of the advances in paediatric respiratory research presented at the ERS International Congress 2022. The eight scientific groups of this Assembly cover a wide range of research areas, including respiratory physiology and sleep, asthma and allergy, cystic fibrosis (CF), respiratory infection and immunology, neonatology and intensive care, respiratory epidemiology, bronchology, and lung and airway developmental biology. Specifically, we report on abstracts presented at the congress on the effect of high altitude on sleep, sleep disorders, the hypoxic challenge test, and measurements of ventilation inhomogeneity. We discuss prevention of preschool wheeze and asthma, and new asthma medications. In children with CF, we describe how to monitor the effect of CF transmembrane conductance regulator modulator therapy. We present respiratory manifestations and chronic lung disease associated with common variable immunodeficiency. Furthermore, we discuss how to monitor respiratory function in neonatal and paediatric intensive care units. In respiratory epidemiology, we present the latest news from population-based and clinical cohort studies. We also focus on innovative and interventional procedures for the paediatric airway, such as cryotherapy. Finally, we stress the importance of better understanding the molecular mechanisms underlying normal and abnormal lung development.
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Affiliation(s)
| | - Katharina Kainz
- Klinik Ottakring, Wilhelminen Hospital, Department of Paediatrics, Teaching Hospital of the University of Vienna, Vienna, Austria
| | - Maria Christina Mallet
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Laura Petrarca
- Translational and Precision Medicine Department, “Sapienza” University of Rome, Rome, Italy
- Maternal Infantile and Urological Sciences Department, “Sapienza” University of Rome, Rome, Italy
| | - Jasna Rodman Berlot
- Department of Paediatric Pulmonology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Monique Slaats
- Department of Paediatrics, Division of Paediatric Respiratory Medicine and Allergology, Erasmus MC – Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands
| | - Carmen Streibel
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Susanne Vijverberg
- Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Pediatric Pulmonology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Emma E. Williams
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Diane M. Gray
- Department of Paediatric Pulmonology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Anna Lavizzari
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milan, Italy
| | - Rory E. Morty
- Department of Lung Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
- Department of Translational Pulmonology and the Translational Lung Research Center Heidelberg, University Hospital Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Marijke Proesmans
- Department of Pediatrics, Pediatric Pulmonology, University Hospital of Leuven, Leuven, Belgium
| | - Dirk Schramm
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Mirjam Stahl
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZL, Berlin, Germany
- Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Angela Zacharasiewicz
- Klinik Ottakring, Wilhelminen Hospital, Department of Paediatrics, Teaching Hospital of the University of Vienna, Vienna, Austria
| | - Alexander Moeller
- Department of Paediatric Pulmonology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mariëlle W. Pijnenburg
- Department of Paediatrics, Division of Paediatric Respiratory Medicine and Allergology, Erasmus MC – Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands
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Zannin E, Rigotti C, Neumann RP, Dellacà RL, Schulzke S, Ventura ML. Oscillatory mechanics in very preterm infants on continuous positive airway pressure support: Reference values. Pediatr Pulmonol 2023; 58:746-752. [PMID: 36416349 DOI: 10.1002/ppul.26247] [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: 06/17/2022] [Revised: 09/28/2022] [Accepted: 11/13/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To create reference values for respiratory system resistance (Rrs) and reactance (Xrs) measured by the forced oscillation technique (FOT) in nonintubated very preterm infants. DESIGN Retrospective analysis of data collected as part of prospective observational studies in two centers. SETTING Tertiary neonatal intensive care units. PATIENTS Non-intubated infants below 32 weeks' gestation age who did not develop bronchopulmonary dysplasia. INTERVENTIONS We applied FOT using a mechanical ventilator (Fabian HFOi; Vyaire) that superimposed small-amplitude oscillations (10 Hz) on a continuous positive airway pressure of 3 and 5 cmH2 O. Measurements were performed during regular tidal breathing using a face mask. MAIN OUTCOME MEASURES We analyzed 198 measurements performed between 7 postnatal days and 40 weeks postmenstrual age (PMA) in 85 infants, with a median (Q1, Q3) gestational age of 30.43 (29.14, 31.18) weeks. Logarithmic transformations were applied to Rrs and Xrs, and the relationship between transformed impedance values and demographic factors was examined by backwards stepwise linear regression. RESULTS In univariable analysis, transformed Xrs was significantly associated with PMA, postnatal age, weight, and length, while Rrs was not. The best multivariable regression model estimating transformed Xrs (cmH2 O*s/L) at continuous positive airway pressure (CPAP) = 5 cmH2 O was: Ln(50 - Xrs) = 4.536 - 0.009 x PMA - 0.014 x weight z-score. SEE = 0.053, R2 = 0.36. The mean (SD) Rrs at CPAP = 5 cmH2 O was 33.63 (5.28) cmH2 O*s/L. CONCLUSION We have established reference values for Rrs and Xrs at 10 Hz in nonintubated preterm neonates on continuous positive airway pressure support.
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Affiliation(s)
- Emanuela Zannin
- UO Neonatologia e Terapia Intensiva Neonatale, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Monza, Italy.,TechRes Lab, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milan, Italy
| | - Camilla Rigotti
- UO Neonatologia e Terapia Intensiva Neonatale, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Monza, Italy
| | - Roland P Neumann
- Department of Neonatology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Raffaele L Dellacà
- TechRes Lab, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milan, Italy
| | - Sven Schulzke
- Department of Neonatology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Maria L Ventura
- UO Neonatologia e Terapia Intensiva Neonatale, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Monza, Italy
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7
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Rigotti C, Zannin E, Veneroni C, Ventura ML, Dellacà RL. Oscillatory Mechanics Response to Inhaled Bronchodilators in Very Preterm Infants: A Retrospective Study. J Pediatr 2022; 251:149-155. [PMID: 35944717 DOI: 10.1016/j.jpeds.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/27/2022] [Accepted: 08/02/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVES To identify short-term repeatability of forced oscillation technique (FOT) measurement of lung function, assess the lung function response to bronchodilators (BDs) by FOT, and prove the concept that only some very preterm infants manifest a change in lung mechanics in response to BD. STUDY DESIGN We retrospectively analyzed respiratory system resistance and respiratory system reactance measured by FOT (Fabian HFOi). The measurement short-term repeatability was assessed in 43 patients on 60 occasions; BD responsiveness was assessed using a different data set, including 38 measurements in 18 infants. The coefficient of repeatability was calculated as twice the SD of differences between measurements performed 15 minutes apart. We assessed BD responsiveness by measuring respiratory system resistance and respiratory system reactance before and 15 minutes after administering 200 mcg/kg of nebulized salbutamol. A positive response was defined as an improvement in respiratory system resistance or respiratory system reactance greater than the identified coefficient of repeatability. RESULTS The coefficient of repeatability was 7.5 cmH2O∗s/L (21%) for respiratory system resistance and 6.3 cmH2O∗s/L (21%) for respiratory system reactance. On average, respiratory system resistance did not change significantly following BD administration, though respiratory system reactance increased significantly (from -32.0 [-50.2, -24.4] to -27.9 [-38.1, -22.0] cmH2O∗s/L, P < .001). Changes in respiratory system resistance or respiratory system reactance after BD were greater than the identified coefficient of repeatability in 8 infants (44%) on 13 (34%) occasions. CONCLUSIONS We identified a threshold to assess BD responsiveness by FOT in preterm infants. We speculate that FOT could be used to assess and personalize treatment with BD.
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Affiliation(s)
- Camilla Rigotti
- Neonatal Intensive Care Unit, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Monza, Italy
| | - Emanuela Zannin
- Neonatal Intensive Care Unit, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Monza, Italy
| | - Chiara Veneroni
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Maria Luisa Ventura
- Neonatal Intensive Care Unit, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Monza, Italy
| | - Raffaele L Dellacà
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
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8
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Bossé Y. Understanding the fundamentals of oscillometry from a strip of lung tissue. Front Physiol 2022; 13:978332. [PMID: 36203932 PMCID: PMC9530782 DOI: 10.3389/fphys.2022.978332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 09/08/2022] [Indexed: 11/19/2022] Open
Abstract
Metrics used in spirometry caught on in respiratory medicine not only because they provide information of clinical importance but also because of a keen understanding of what is being measured. The forced expiratory volume in 1 s (FEV1), for example, is the maximal volume of air that can be expelled during the first second of a forced expiratory maneuver starting from a lung inflated to total lung capacity (TLC). Although it represents a very gross measurement of lung function, it is now used to guide the diagnosis and management of many lung disorders. Metrics used in oscillometry are not as concrete. Resistance, for example, has several connotations and its proper meaning in the context of a lung probed by an external device is not always intuitive. I think that the popularization of oscillometry and its firm implementation in respiratory guidelines starts with a keen understanding of what exactly is being measured. This review is an attempt to clearly explain the basic metrics of oscillometry. In my opinion, the fundamentals of oscillometry can be understood using a simple example of an excised strip of lung tissue subjected to a sinusoidal strain. The key notion is to divide the sinusoidal reacting force from the tissue strip into two sinusoids, one in phase with the strain and one preceding the strain by exactly a quarter of a cycle. Similar notions can then be applied to a whole lung subjected to a sinusoidal flow imposed at the mouth by an external device to understand basic metrics of oscillometry, including resistance, elastance, impedance, inertance, reactance and resonant frequency.
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