1
|
Rigotti C, Zannin E, Abdelfattah AS, Ventura ML, Dellacà RL. Assessment of bronchodilator response by forced oscillation technique in a preterm infant with evolving bronchopulmonary dysplasia: A case report. Pediatr Pulmonol 2022; 57:1092-1095. [PMID: 34970872 DOI: 10.1002/ppul.25812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/13/2021] [Accepted: 12/29/2021] [Indexed: 11/12/2022]
Abstract
Inhaled bronchodilators are often given in preterm infants with evolving or established bronchopulmonary dysplasia. However, it is unclear which patients may benefit from it and when it is the best time to start treatment. The forced oscillation technique (FOT) is a noninvasive method for assessing lung mechanics that proved sensitive to airway obstruction reversibility in children and adults. FOT does not need patient cooperation, which is ideal for infants. Bedside tools for applying FOT in infants during spontaneous breathing and different respiratory support modes are becoming available. This case report illustrates for the first time that FOT has potential value in assessing airway obstruction reversibility in preterm infants, informing which infants may manifest a clinical benefit from the treatment with bronchodilators.
Collapse
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
| | - Abedulrhman S Abdelfattah
- Neonatal Intensive Care Unit, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Monza, Italy.,Pediatric Department, School of Medicine, Hashemite University, Zarqa, Jordan
| | - 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
| |
Collapse
|
2
|
Beretta F, Lavizzari A, Pesenti N, Arkhangelskaia T, Ciuffini F, Ophorst M, Gangi S, Colnaghi M, Morniroli D, Mosca F, Giannì ML. Effect of human milk and other neonatal variables on lung function at three months corrected age. Pediatr Pulmonol 2021; 56:3832-3838. [PMID: 34407314 DOI: 10.1002/ppul.25625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/13/2021] [Accepted: 08/04/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the impact of human milk and different neonatal variables on tidal breathing flow-volume loop (TBFVL) parameters within three months' corrected age (CA) in infants born ≤32 wks or weighing <1500 g. METHODS We retrospectively studied 121 infants with gestational age (GA) ≤ 32 weeks or birth weight (BW) <1500 gr who had lung function assessment within three months' CA by TBFVL analysis between June 2009 and April 2018. We investigated the impact of GA, gender, being Small for GA (SGA), sepsis, days of mechanical ventilation (MV) and human milk feeding (HMF) on later respiratory function, both in the entire group and according to BW ( ≤1000 g and >1000 g). RESULTS The mean(SD) z-score for tidal volume (Vt) and time to peak expiratory flow to expiratory time (tPTEF/tE) were respectively -4.3 (2.5) and -0.8 (2.0) for the overall population with no significant differences between infants <1000 g or ≥1000 g. The mean(SD) Vt standardized for body weight was 6.2(2.0) ml/kg. Being female was associated with better Vt/Kg, whereas longer MV or being born SGA were associated with worst tPTEF/tE. For infants with BW < 1000 gr, tPTEF/tE was positively associated with HMF. CONCLUSION An early TBFVL assessment within three months' CA already reveals lung function alteration in preterm infants. Being female is associated with better Vt/Kg, while longer duration of MV or being born SGA negatively affect tPTEF/tE. The positive association between HMF and better tPTEF/tE in infants with BW <1000 g has emerged, which deserves further investigation.
Collapse
Affiliation(s)
- Francesco Beretta
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Lavizzari
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Pesenti
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Taja Arkhangelskaia
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Ciuffini
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marijke Ophorst
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvana Gangi
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mariarosa Colnaghi
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Morniroli
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maria L Giannì
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| |
Collapse
|
3
|
Lee J, Parikka V, Lehtonen L, Soukka H. Backup ventilation during neurally adjusted ventilatory assist in preterm infants. Pediatr Pulmonol 2021; 56:3342-3348. [PMID: 34310871 DOI: 10.1002/ppul.25583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/30/2021] [Accepted: 07/14/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To analyze the proportion of backup ventilation during neurally adjusted ventilatory assist (NAVA) in preterm infants at different postmenstrual ages (PMAs) and to analyze the trends in backup ventilation in relation to clinical deteriorations. METHODS A prospective observational study was conducted in 18 preterm infants born at a median (range) 27+4 (23+4 -34+4 ) weeks of gestation with a median (range) birth weight of 1,100 (460-2,820) g, who received respiratory support with either invasive or noninvasive NAVA. Data on ventilator settings and respiratory variables were collected daily; the mean values of each 24-h recording were computed for each respiratory variable. For clinical deterioration, ventilator data were reviewed at 6-h intervals for 30 h before the event. RESULTS A total of 354 patient days were included: 269 and 85 days during invasive and noninvasive NAVA, respectively. The time on backup ventilation (%/min) significantly decreased with increasing PMA during both invasive and noninvasive NAVA. The neural respiratory rate did not change over time. The median time on backup ventilation was less than 15%/min, and the median neural respiratory rate was more than 45 breaths/min for infants above 26+0 weeks PMA during invasive NAVA. The relative backup ventilation significantly increased before the episode of clinical deterioration. CONCLUSION The proportion of backup ventilation during NAVA showed how the control of breathing matured with increasing PMA. Even the most immature infants triggered most of their breaths by their own respiratory effort. An acute increase in the proportion of backup ventilation anticipated clinical deterioration.
Collapse
Affiliation(s)
- Juyoung Lee
- Department of Pediatrics, Inha University Hospital, Incheon, South Korea
- Department of Pediatrics, Inha University College of Medicine, Incheon, South Korea
| | - Vilhelmiina Parikka
- Department of Pediatrics, Turku University Hospital, Turku, Finland
- Department of Pediatrics, University of Turku, Turku, Finland
| | - Liisa Lehtonen
- Department of Pediatrics, Turku University Hospital, Turku, Finland
- Department of Pediatrics, University of Turku, Turku, Finland
| | - Hanna Soukka
- Department of Pediatrics, Turku University Hospital, Turku, Finland
- Department of Pediatrics, University of Turku, Turku, Finland
| |
Collapse
|
4
|
Muston HN, Slaven JE, Tiller C, Clem C, Ferkol TW, Ranganathan S, Davis SD, Ren CL. Hyperinflation is associated with increased respiratory rate and is a more sensitive measure of cystic fibrosis lung disease during infancy compared to forced expiratory measures. Pediatr Pulmonol 2021; 56:2854-2860. [PMID: 34143539 PMCID: PMC8373786 DOI: 10.1002/ppul.25538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND The goal of this study was to identify clinical features associated with abnormal infant pulmonary function tests (iPFTs), specifically functional residual capacity (FRC), in infants with cystic fibrosis (CF) diagnosed via newborn screen (NBS). We hypothesized that poor nutritional status in the first 6-12 months would be associated with increased FRC at 12-24 months. METHODS This study utilized a combination of retrospectively and prospectively collected data from ongoing research studies and iPFTs performed for clinical indications. Demographic and clinical features were obtained from the electronic medical record. Forced expiratory flows and volumes were obtained using the raised volume rapid thoracoabdominal technique (RVRTC) and FRC was measured via plethysmography. RESULTS A total of 45 CF NBS infants had iPFTs performed between 12 and 24 months. Mean forced vital capacity, forced expiratory volume in 0.5 s, and forced expiratory flows were all within normal limits. In contrast, the mean FRC z-score was 2.18 (95% confidence interval [CI] = 1.48, 2.88) and the mean respiratory rate (RR) z-score was 1.42 (95% CI = 0.95, 1.89). There was no significant association between poor nutritional status and abnormal lung function. However, there was a significant association between higher RR and increased FRC, and a RR cutoff of 36 breaths/min resulted in 92% sensitivity to detect hyperinflation with 32% specificity. CONCLUSION These results suggest that FRC is a more sensitive measure of early CF lung disease than RVRTC measurements and that RR may be a simple, noninvasive clinical marker to identify CF NBS infants with hyperinflation.
Collapse
Affiliation(s)
- Heather N Muston
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Christina Tiller
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Charles Clem
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Thomas W Ferkol
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Sarath Ranganathan
- Department of Paediatrics, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| | - Stephanie D Davis
- Department of Pediatrics, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Clement L Ren
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
5
|
Balinotti JE, Maffey A, Colom A, Roldán O, Díaz W, Medín M, Racimo M, Teper A. Clinical, functional, and computed tomography findings in a cohort of patients with neuroendocrine cell hyperplasia of infancy. Pediatr Pulmonol 2021; 56:1681-1686. [PMID: 33580744 DOI: 10.1002/ppul.25319] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/16/2021] [Accepted: 02/09/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Neuroendocrine cell hyperplasia of infancy (NEHI) is one of the most common interstitial lung diseases in children. Both the etiology and pathophysiological mechanisms of the disease are still unknown. Prognosis is usually favorable; however, there are significant morbidities during the early years of life. OBJECTIVE To describe the clinical course, infant pulmonary function tests and computed tomography (CT) findings in a cohort of patients with NEHI in Argentina. METHODS This is a observational multicenter cohort study of children diagnosed with NEHI between 2011 and 2020. RESULTS Twenty patients participated in this study. The median age of onset of symptoms was 3 months and the median age at diagnosis was 6 months. The most common clinical presentation was tachypnea, retractions and hypoxemia. The chest CT findings showed central ground glass opacities and air trapping. Infant pulmonary function tests revealed an obstructive pattern in 75% of the cases (10/12). Most patients (75%) required home oxygen therapy for 17 months (interquartile range 12-25). In 85% of them, tachypnea and hypoxemia spontaneously resolved between the second and third years of life. CONCLUSION In this cohort, the first symptoms appeared during the early months of life. The typical clinical, CT, and functional findings allowed the diagnosis without the need of a lung biopsy. Although most patients required home oxygen therapy, they showed a favorable evolution.
Collapse
Affiliation(s)
- Juan E Balinotti
- Department of Medicine, Respiratory Center, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Alberto Maffey
- Department of Medicine, Respiratory Center, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Alejandro Colom
- Department of Medicine, Respiratory Center, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Oscar Roldán
- Division of Pediatric, Sanatorio del Salvador, Córdoba, Argentina
| | - Walter Díaz
- Division of Pediatric, Alexander Fleming Hospital, Mendoza, Argentina
| | - Martín Medín
- Department of Pathology, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Mariano Racimo
- Department of Medicine, Respiratory Center, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Alejandro Teper
- Department of Medicine, Respiratory Center, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| |
Collapse
|
6
|
Rhoads E, Wall BL, Ren CL. Pediatric pulmonology year in review 2019: Physiology. Pediatr Pulmonol 2020; 55:2848-2852. [PMID: 32729952 DOI: 10.1002/ppul.24995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/02/2020] [Accepted: 07/05/2020] [Indexed: 11/07/2022]
Abstract
Pulmonary physiologic assessments are critical for the care and study of pediatric respiratory disease. In 2019, there were numerous contributions to this topic in Pediatric Pulmonology.
Collapse
Affiliation(s)
- Eli Rhoads
- Division of Pediatric Pulmonology, Allergy, and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Riley Hospital for Children, Indianapolis, Indiana
| | - Brittany L Wall
- Division of Pediatric Pulmonology, Allergy, and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Riley Hospital for Children, Indianapolis, Indiana
| | - Clement L Ren
- Division of Pediatric Pulmonology, Allergy, and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Riley Hospital for Children, Indianapolis, Indiana
| |
Collapse
|
7
|
Manti S, Esper F, Alejandro-Rodriguez M, Leonardi S, Betta P, Cuppari C, Lanzafame A, Worley S, Salpietro C, Perez MK, Rezaee F, Piedimonte G. Respiratory syncytial virus seropositivity at birth is associated with adverse neonatal respiratory outcomes. Pediatr Pulmonol 2020; 55:3074-3079. [PMID: 32741145 PMCID: PMC7808412 DOI: 10.1002/ppul.25001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND More than 60 years since the discovery of the respiratory syncytial virus (RSV), the effects of prenatal exposure to this virus remain largely unknown. In this investigation, we sought to find evidence of RSV seroconversion in cord blood and explore its clinical implications for the newborn. METHODS Offspring from 22 pregnant women with a history of viral respiratory infection during the third trimester of pregnancy (respiratory viral illness [RVI] group) and 40 controls were enrolled in this study between 1 September 2016 and 31 March 2019. Cord blood sera were tested for anti-RSV antibodies by indirect fluorescent antibody assay. RSV seropositivity was defined as the presence of anti-RSV immunoglobulin M (IgM) or immunoglobulin A (IgA), in addition to IgG in cord blood serum at ≥1:20 dilution. RESULTS Anti-RSV IgG was present in all cord blood serum samples from infants born to RVI mothers (95% confidence interval [CI] = 82%-100%), with 16 samples also having elevated titers for either anti-RSV IgA or IgM (73%; 95% CI = 52%-87%). No controls had evidence of anti-RSV antibodies. Eight (50%) seropositive newborns developed at least one respiratory tract finding, including respiratory distress syndrome (N = 8), respiratory failure (N = 3), and pneumonia (N = 1). RSV seropositive newborns also required more days on oxygen, had leukocytosis and elevated C-reactive protein (P = .025, P = .047, and P < .001, respectively). CONCLUSION This study provides evidence of acute seropositivity against RSV in cord blood of newborns delivered from mothers with a history of upper respiratory tract illness in the third trimester. Cord blood seropositivity for anti-RSV IgA or IgM was associated with adverse clinical and laboratory outcomes in newborns.
Collapse
Affiliation(s)
- Sara Manti
- Cleveland Clinic Center for Pediatric Research, Lerner Research Institute, Cleveland, Ohio, United States
- Department of Pediatrics, Unit of Pediatric Genetics and Immunology, University of Messina, Messina, Italy
| | - Frank Esper
- Cleveland Clinic Center for Pediatric Research, Lerner Research Institute, Cleveland, Ohio, United States
- Center for Pediatric Infectious Diseases, Cleveland Clinic Children’s, Cleveland, Ohio, United States
| | | | - Salvatore Leonardi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Pasqua Betta
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Caterina Cuppari
- Department of Pediatrics, Unit of Pediatric Genetics and Immunology, University of Messina, Messina, Italy
| | - Angela Lanzafame
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Sarah Worley
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, United States
| | - Carmelo Salpietro
- Department of Pediatrics, Unit of Pediatric Genetics and Immunology, University of Messina, Messina, Italy
| | - Miriam K. Perez
- Cleveland Clinic Center for Pediatric Research, Lerner Research Institute, Cleveland, Ohio, United States
| | - Fariba Rezaee
- Cleveland Clinic Center for Pediatric Research, Lerner Research Institute, Cleveland, Ohio, United States
| | - Giovanni Piedimonte
- Departments of Pediatrics, Biochemistry and Molecular Biology, Tulane University School of Medicine, New Orleans, Louisiana, United States
| |
Collapse
|
8
|
Gutiérrez-Delgado RI, Barraza-Villarreal A, Escamilla-Núñez MC, Hernández-Cadena L, Cortez-Lugo M, Sly P, Romieu I. Prenatal exposure to VOCs and NOx and lung function in preschoolers. Pediatr Pulmonol 2020; 55:2142-2149. [PMID: 32510180 PMCID: PMC7485223 DOI: 10.1002/ppul.24889] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Several studies have shown that exposure to air pollutants affects lung growth and development and can result in poor respiratory health in early life. METHODS We included a subsample of 772 Mexican preschoolers whose mothers participated in a Prenatal Omega-3 fatty acid Supplements, GRowth, And Development birth cohort study with the aim to evaluate the impact of prenatal exposure to volatile organic compounds and nitrogen oxides on lung function measured by oscillation tests. The preschoolers were followed until 5 years of age. Anthropometric measurements and forced oscillation tests were performed at 36, 48, and 60 months of age. Information on sociodemographic and health characteristics was obtained during follow up. Prenatal exposure to volatile organic compounds and nitrogen oxides was evaluated using a land use regression models and the association between them was tested using a lineal regression and longitudinal linear mixed effect models adjusting for potential confounders. RESULTS Overall, the mean (standard deviation) of the measurements of respiratory system resistance and respiratory system reactance at 6, 8, and 10 Hz during the follow-up period was 11.3 (2.4), 11.1 (2.4), 10.3 (2.2) and -5.2 (1.6), -4.8 (1.7), and -4.6 hPa s L-1 (1.6), respectively. We found a significantly positive association between respiratory resistance (βRrs6 = 0.011; 95%CI: 0.001, 0.023) (P < .05) and prenatal exposure to nitrogen dioxide and a marginally negatively association between respiratory reactance (βXrs6 = -11.40 95%CI: -25.26, 1.17 and βXrs8 = -11.91 95%CI: -26.51, 1.43) (P = .07) and prenatal exposure to xylene. CONCLUSION Prenatal exposure to air pollutants was significantly associated with the alteration of lung function measured by oscillation tests in these preschool children.
Collapse
Affiliation(s)
- Rosa I Gutiérrez-Delgado
- Departamento de Salud Ambiental, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | | | - María C Escamilla-Núñez
- Departamento de Salud Ambiental, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Leticia Hernández-Cadena
- Departamento de Salud Ambiental, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Marlene Cortez-Lugo
- Departamento de Salud Ambiental, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Peter Sly
- Department of Children's Health and Environment, The University of Queensland, Brisbane, Queensland, Australia.,WHO Collaborating Centre for Research on Children's Environmental Health, Perth, Australia
| | - Isabelle Romieu
- Departamento de Salud Ambiental, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| |
Collapse
|
9
|
Chotzoglou E, Hedrick HL, Herkert LM, Goldshore MA, Rintoul NE, Panitch HB. Therapy at 30 days of life predicts lung function at 6 to 12 months in infants with congenital diaphragmatic hernia. Pediatr Pulmonol 2020; 55:1456-1467. [PMID: 32191392 DOI: 10.1002/ppul.24736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/09/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Congenital diaphragmatic hernia (CDH) is associated with variable degrees of lung hypoplasia. Pulmonary support at 30 days postnatal age was found to be the strongest predictor of inpatient mortality and morbidity among CDH infants and was also associated with higher pulmonary morbidity at 1 and 5 years. It is not known, however, if there is a relationship between the need for medical therapy at 30 days of life and subsequent abnormalities in lung function as reflected in infant pulmonary function test (iPFT) measurements. OBJECTIVE We hypothesized that CDH infants who require more intensive therapy at 30 days would have more abnormal iPFT values at the time of their first infant pulmonary function study, reflecting the more severe spectrum of lung hypoplasia. METHODS A single-institution chart review of all CDH survivors who were enrolled in a Pulmonary Hypoplasia Program (PHP) through July 2019, and treated from 2002 to 2019 was performed. All infants were divided into groups based on their need for noninvasive (supplemental oxygen, high flow therapy, noninvasive mechanical ventilation) or invasive (mechanical ventilation, extracorporeal membrane oxygenation) respiratory assistance, bronchodilators, diuretic use, and pulmonary hypertension (PH) therapy (inhaled and/or systemic drugs) at 30 days. Descriptive and statistical analyses were performed between groups comparing subsequent lung function measurements. RESULTS A total of 382 infants (median gestational age [GA] 38.4 [interquartile range (IQR) = 37.1-39] weeks, 41.8% female, 70.9% Caucasian) with CDH were enrolled in the PHP through July 2019, and 118 infants underwent iPFT. The median age of the first iPFT was 6.6 (IQR = 5.3-11.7) months. Those requiring any pulmonary support at 30 days had a higher functional residual capacity (FRC) (z) (P = .03), residual volume (RV) (z) (P = .008), ratio of RV to total lung capacity (RV/TLC) (z) (P = .0001), and ratio of FRC to TLC (FRC/TLC) (z) (P = .001); a lower forced expiratory volume at 0.5 seconds (FEV0.5) (z) (P = .03) and a lower respiratory system compliance (Crs) (P = .01) than those who did not require any support. Similarly, those requiring diuretics and/or PH therapy at 30 days had higher fractional lung volumes, lower forced expiratory flows and Crs than infants who did not require such support (P < .05). CONCLUSIONS Infants requiring any pulmonary support, diuretics and/or PH therapy at 30 postnatal days have lower forced expiratory flows and higher fractional lung volumes, suggesting a greater degree of lung hypoplasia. Our study suggests that the continued need for PH, diuretic or pulmonary support therapy at 30 days can be used as additional risk-stratification measurements for evaluation of infants with CDH.
Collapse
Affiliation(s)
- Etze Chotzoglou
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of General Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Holly L Hedrick
- Department of General Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lisa M Herkert
- Department of General Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matthew A Goldshore
- Department of General Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Natalie E Rintoul
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Howard B Panitch
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
10
|
Sanchez-Solis M, Garcia-Marcos PW, Agüera-Arenas J, Mondejar-Lopez P, Garcia-Marcos L. Impact of early caffeine therapy in preterm newborns on infant lung function. Pediatr Pulmonol 2020; 55:102-107. [PMID: 31587528 DOI: 10.1002/ppul.24540] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/12/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To know the effect of caffeine therapy on infant lung function in preterm infants with a gestational age less than 31 weeks. MATERIAL AND METHODS Forced vital capacity (FVC), forced expiratory volume at 0.5 seconds (FEV0.5 ), and forced expiratory flows were measured by raised volume rapid thoracoabdominal compression technique; functional residual capacity was measured by plethysmography (FRCpleth ). Compliance of the respiratory system was measured by a single interruption technique (Crs). The Student t test was used to compare lung function measurements between the two groups: treated versus nontreated with caffeine. A multivariate analysis was carried out considering each and every lung function parameter (z-score) as the dependent variable; and gender, gestational age, birth weight (z-score), corrected age, invasive mechanical ventilation (yes/no), and bronchopulmonary dysplasia (BPD) diagnosis (yes/no) as independent ones. Additionally, stratified analyses by BPD diagnosis were performed. RESULTS The multivariate analysis showed significant higher z-scores of FVC and FEV0.5 in preterm infants treated with caffeine (P = .004 and P = .024, respectively). This result only being significant in the group of non-BPD infants (P = .021 and P = .042), after stratifying by BPD diagnosis. Differences were not found in z-scores of FEV0.5/FVC, FEF75, FEF25-75, FRCpleth, nor Crs. CONCLUSION Lung function (FVC and FEV0.5 ) is improved in infants born under 31 weeks of gestation when treated with caffeine. This improvement is driven by the group of infants who did not suffer from BPD. Overall, our results show that there is an early beneficial effect of caffeine treatment in infant lung function.
Collapse
Affiliation(s)
- Manuel Sanchez-Solis
- Surgery, Pediatric, Obstetric and Gynecology Department, University of Murcia, Murcia, Spain.,Biomedical Research Institute Virgen de la Arrixaca of Murcia (IMIB-Arrixaca), Murcia, Spain
| | - Patricia W Garcia-Marcos
- Pediatric Pulmonology and Cystic Fibrosis Unit, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Juan Agüera-Arenas
- Department of Pediatrics-Neonatology, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Pedro Mondejar-Lopez
- Pediatric Pulmonology and Cystic Fibrosis Unit, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Luis Garcia-Marcos
- Surgery, Pediatric, Obstetric and Gynecology Department, University of Murcia, Murcia, Spain.,Biomedical Research Institute Virgen de la Arrixaca of Murcia (IMIB-Arrixaca), Murcia, Spain
| |
Collapse
|
11
|
Yoder LM, Higano NS, Schapiro AH, Fleck RJ, Hysinger EB, Bates AJ, Kingma PS, Merhar SL, Fain SB, Woods JC. Elevated lung volumes in neonates with bronchopulmonary dysplasia measured via MRI. Pediatr Pulmonol 2019; 54:1311-1318. [PMID: 31134768 DOI: 10.1002/ppul.24378] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 03/11/2019] [Accepted: 05/01/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) is a chronic lung disease of prematurity defined by requirement for respiratory support at 36 weeks postmenstrual age (PMA), but structural sequelae like lung hyperinflation are often not quantified. Quiet-breathing, nonsedated magnetic resonance imaging (MRI) allows tomographic quantification of lung volumes and densities. We hypothesized that functional residual capacity (FRC) and intrapleural volume (IV) are increased in BPD and correlate with qualitative radiological scoring of hyperinflation. METHODS Ultrashort echo time (UTE) MRI of 17 neonates (acquired at ~39 weeks PMA) were reconstructed at end-expiration and end-inspiration via the time course of the k0 point in k-space. Images were segmented to determine total lung, tidal, parenchymal tissue, and vascular tissue volumes. FRC was calculated by subtracting parenchymal and vascular tissue volumes from IV. Respiratory rate (RR) was calculated via the UTE respiratory waveform, yielding estimates of minute ventilation when combined with tidal volumes (TVs). Two radiologists scored hyperinflation on the MR images. RESULTS IV at FRC increased in BPD: for control, mild, and severe (patients the median volumes were 32.8, 33.5, and 50.9 mL/kg, respectively. TV (medians: 2.21, 3.64, and 4.84 mL/kg) and minute ventilation (medians: 493, 750, and 991 mL/min) increased with increasing severity of BPD (despite decreasing RR, medians: 75.6, 63.0, and 56.1 breaths/min). FRC increased with increasing severity of BPD (39.3, 38.3, and 56.0 mL, respectively). Findings were consistent with increased hyperinflation scored by radiologists. CONCLUSIONS This study demonstrates that UTE MRI can quantify hyperinflation in neonatal BPD and that lung volumes significantly increase with disease severity.
Collapse
Affiliation(s)
- Lauren M Yoder
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Nara S Higano
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Andrew H Schapiro
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Robert J Fleck
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Erik B Hysinger
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Alister J Bates
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Paul S Kingma
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stephanie L Merhar
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sean B Fain
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Medical Physics, University of Wisconsin, Madison, Wisconsin.,Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| |
Collapse
|
12
|
Shawcross A, Murray CS, Pike K, Horsley A. A novel method for infant multiple breath washout: First report in clinical practice. Pediatr Pulmonol 2019; 54:1284-1290. [PMID: 31211518 DOI: 10.1002/ppul.24384] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/23/2018] [Accepted: 11/30/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Lung clearance index (LCI), measured using multiple breath inert gas washout (MBW) is a potentially useful test in infants with respiratory disease, particularly cystic fibrosis (CF). Clinical use is limited however by the need for specialist staff and equipment. We have previously described a novel method for infant MBW suitable for use outside of specialist laboratories. This study describes its performance in vivo in infants with CF and healthy controls, including a limited comparison with the respiratory mass spectrometer. METHODS Children aged less than 2 years with CF and controls underwent MBW testing on a single occasion. The practical applicability of the system was determined by the number of successful duplicate tests and within-subject repeatability. RESULTS Twenty-five children (seven with CF, 18 healthy controls, all sedated with chloral hydrate) attempted MBW. Twenty patients (seven with CF) successfully underwent duplicate testing (80% success rate). Mean within-subject coefficient of variation for functional residual capacity (FRC) was 7.2% and for LCI 5.9%. Comparison of LCI with the mass spectrometer was limited but gave very similar values for LCI and FRC in those patients who underwent technically adequate tests with both methods. CONCLUSIONS We have described a new MBW method that is feasible and reproducible in sedated infants. Results fall within the expected range, and well within accuracy limits set by international guidelines. This could provide a more accessible alternative to previously described systems for infant MBW, and overcomes many of the technical challenges inherent in conventional MBW.
Collapse
Affiliation(s)
- Anna Shawcross
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Department of Paediatric Respiratory Medicine, Royal Manchester Children's Hospital, Manchester, UK
| | - Clare S Murray
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Department of Paediatric Respiratory Medicine, Royal Manchester Children's Hospital, Manchester, UK
| | - Katy Pike
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK.,Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Alex Horsley
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Manchester Adult Cystic Fibrosis Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| |
Collapse
|
13
|
McEvoy CT, Shorey-Kendrick LE, Milner K, Schilling D, Tiller C, Vuylsteke B, Scherman A, Jackson K, Haas DM, Harris J, Schuff R, Park BS, Vu A, Kraemer DF, Mitchell J, Metz J, Gonzales D, Bunten C, Spindel ER, Tepper RS, Morris CD. Oral Vitamin C (500 mg/d) to Pregnant Smokers Improves Infant Airway Function at 3 Months (VCSIP). A Randomized Trial. Am J Respir Crit Care Med 2019; 199:1139-1147. [PMID: 30522343 PMCID: PMC6515875 DOI: 10.1164/rccm.201805-1011oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 12/07/2018] [Indexed: 11/16/2022] Open
Abstract
Rationale: We reported a randomized trial demonstrating daily supplemental vitamin C to pregnant smokers significantly improved newborn pulmonary function tests. The current study tests these results in a new cohort using infant pulmonary function tests. Objectives: To determine if infants of pregnant smokers randomized to daily supplemental vitamin C would have improved forced expiratory flows (FEFs) at 3 months of age compared with those randomized to placebo, and to investigate the association of the α5 nicotinic acetylcholine receptor. Methods: A randomized, double-blind, placebo-controlled trial was conducted at three centers. Two hundred fifty-one pregnant smokers were randomized at 13-23 weeks of gestation: 125 randomized to vitamin C (500 mg/d) and 126 to placebo. Measurements and Main Results: The primary outcome was FEF75 at 3 months of age performed with the raised volume rapid thoracic compression technique (Jaeger/Viasys). FEF50 and FEF25-75 obtained from the same expiratory curves were prespecified secondary outcomes. The infants of pregnant smokers randomized to vitamin C (n = 113) had the following FEFs at 3 months of age compared with those randomized to placebo (n = 109) as measured by FEF75 (200.7 vs. 188.7 ml/s; adjusted 95% confidence interval [CI] for difference, -3.33 to 35.64; P = 0.10), FEF50 (436.7 vs. 408.5 ml/s; adjusted 95% CI for difference, 6.10-61.30; P = 0.02), and FEF25-75 (387.4 vs. 365.8 ml/s; adjusted 95% CI for difference, 0.92-55.34; P = 0.04). Infant FEFs seemed to be negatively associated with the maternal risk alleles for the α5 nicotinic acetylcholine receptor (rs16969968). Conclusions: Although the primary outcome of FEF75 was not improved after vitamin C supplementation to pregnant smokers, the predetermined secondary outcomes FEF50 and FEF25-75 were significantly improved. These results extend our previous findings and demonstrate improved airway function (FEF50 and FEF25-75) at 3 months of age in infants after vitamin C supplementation to pregnant smokers. Clinical trial registered with www.clinicaltrials.gov (NCT01723696).
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Keith Jackson
- PeaceHealth Southwest Medical Center, Vancouver, Washington
| | - David M. Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Robert Schuff
- Department of Medical Informatics and Clinical Epidemiology
- Oregon Clinical & Translational Research Institute, and
| | - Byung S. Park
- Oregon Health & Science University-Portland State University School of Public Health and Knight Cancer Institute, Portland, Oregon; and
| | - Annette Vu
- Department of Medical Informatics and Clinical Epidemiology
| | | | | | - Jill Metz
- Department of Medical Informatics and Clinical Epidemiology
| | - David Gonzales
- Division of Pulmonary & Critical Care Medicine, Oregon Health & Science University, Portland, Oregon
| | | | - Eliot R. Spindel
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, Oregon
| | | | - Cynthia D. Morris
- Department of Medical Informatics and Clinical Epidemiology
- Oregon Clinical & Translational Research Institute, and
| |
Collapse
|
14
|
Schmidt BJ, Reim PS, Jensen AK, Albertsen P, Greisen G, Jørgensen IM. Tidal breath eNO measurements in a cohort of unsedated hospitalized neonates-A method validation. Pediatr Pulmonol 2018; 53:762-771. [PMID: 29701312 DOI: 10.1002/ppul.24019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 04/03/2018] [Indexed: 11/09/2022]
Abstract
AIM Exhaled Nitric oxide (eNO) is an inflammatory marker. In 2002 Hall et al. [J Appl Physiol. 92:59-66] established an infant eNO measurement method, fulfilling four criteria of feasibility: simple, non-invasive, without impact on the natural breathing pattern, and accounting for flow by NO output (V'NO). Although tidal breathing is accepted as an eNO measurement method in uncooperative patients, it is seldom used outside research labs. The variability and lack of validated methods have restrained from exploring the area in preterm and term neonates the last years. This study aimed to validate clinically feasible longitudinal online tidal eNO and V'NO in a real-life birth cohort of un-sedated, hospitalized preterm, and term neonates. METHOD We included 149 newborns, GA 28-42 weeks. Each scheduled for six repeated, non-invasive, on-line eNO measurements with Ecomedics CLD 88sp and NO-free air. We used three 60-second-eNO measurements. The method was adapted to fit preterm and term neonates with unstable respiration, without excluding sighs and surrounding breaths. RESULT Protocol measurements with a maximum mutual difference of 1 ppb succeeded in 85-99%, increasing with postnatal age. We performed mixed model analyses in three hierarchical measurement levels. Despite the irregular breathing of newborns, the predictions of individual eNO levels in the average infant was a 0.05 SD. Exhaled NO was flow-dependent (P = 0.028); V'NO but not eNO was associated with preterm birth (P < 0.001) and >24 h CPAP treatment (P = 0.0316). CONCLUSION We validated clinically, non-invasive, online eNO measurements in neonates. The method was well tolerated and exhibited low subject-specific-prediction-variance and high success rates.
Collapse
Affiliation(s)
- Birgitte J Schmidt
- Department of Pediatrics and Adolescent Medicine, Nordsjaellands Hospital, Hilleroed, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pauline S Reim
- Department of Pediatrics and Adolescent Medicine, Nordsjaellands Hospital, Hilleroed, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andreas K Jensen
- Section of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Research, Nordsjaellands Hospital, Hilleroed, Denmark
| | - Per Albertsen
- Department of Pediatrics and Adolescent Medicine, Nordsjaellands Hospital, Hilleroed, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gorm Greisen
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Neonatology, Rigshospitalet, Copenhagen, Denmark
| | - Inger M Jørgensen
- Department of Pediatrics and Adolescent Medicine, Nordsjaellands Hospital, Hilleroed, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
15
|
McEvoy C, Schilling D, Spitale P, O'Malley J, Bowling S, Durand M. Pulmonary function and outcomes in infants randomized to a rescue course of antenatal steroids. Pediatr Pulmonol 2017; 52:1171-1178. [PMID: 28436580 PMCID: PMC5561489 DOI: 10.1002/ppul.23711] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 04/02/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND/OBJECTIVE Our objective was to obtain follow-up pulmonary function testing and assessment of clinical respiratory outcomes, at 1-2 years, in preterm infants whose mothers were randomized to a single rescue course of antenatal steroids (AS) versus placebo. METHODS Follow-up of a randomized, double-blinded trial. In the original trial pregnant women ≥14 days after initial course of AS were randomized to rescue AS or placebo. Pulmonary function testing and a standardized respiratory questionnaire were obtained at 1-2 years of corrected age. Respiratory compliance (Crs) was measured with the single-breath occlusion and functional residual capacity (FRC) with the nitrogen washout method. Analysis was by intention-to-treat. RESULTS A total of 96 (87%) of available survivors were administered a respiratory questionnaire. Seventy-seven percent of available patients had pulmonary function testing performed. There was no significant difference between groups in incidence of wheezing, asthma, respiratory syncytial virus infection, respiratory readmissions, use of bronchodilators or other medications, or in measurements of pulmonary function. There was also no significant difference in corrected age at study, race, gender, or length at the time of pulmonary function testing. Infants in the rescue group had a comparable mean FRC (249.4 mL vs 246.2 mL; adjusted 95%CI for difference -15.45, 38.20; P = 0.37) versus placebo. There were no differences in tidal volume or Crs. CONCLUSION A rescue course of AS significantly increases Crs within 72 h of age and decreases oxygen need in newborn infants, without an adverse impact on pulmonary function or clinical respiratory outcomes at 1-2 years of age [NCT00669383].
Collapse
Affiliation(s)
- Cindy McEvoy
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon.,Department of Pediatrics, Sacred Heart Hospital, Pensacola, Florida
| | - Diane Schilling
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Patricia Spitale
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Jean O'Malley
- Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon
| | - Susan Bowling
- Department of Pediatrics, Sacred Heart Hospital, Pensacola, Florida
| | - Manuel Durand
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| |
Collapse
|
16
|
Rabasco J, Vigo A, Vitelli O, Noce S, Pietropaoli N, Evangelisti M, Pia Villa M. Apparent life-threatening events could be a wake-up call for sleep disordered breathing. Pediatr Pulmonol 2016; 51:1403-1408. [PMID: 27163733 DOI: 10.1002/ppul.23468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/31/2016] [Accepted: 04/24/2016] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Polysomnographic recordings of children with an apparent life-threatening event (ALTE) have often displayed signs of partial or complete obstruction during sleep. Various studies have focused on facial dysmorphia in infants with ALTE and tried to establish a correlation between ALTE and obstructive sleep apnoea. Our study evaluates the phenotypic characteristics and the presence of sleep disorders in pre-school children who had at least one ALTE in the first year of life. MATERIALS AND METHODS We analyzed a group of pre-school children (mean age 5.21 ± 0.90 years) who were referred for an ALTE between 2008 and 2010. Children with no history of ALTEs were recruited as a control group. A detailed personal and family history was obtained for all the participants. Moreover, all the children underwent a general clinical examination and an ear, nose, and throat and orthodontic assessment. A clinical score was calculated according to the previously validated Sleep Clinical Record (SCR). RESULTS In the ALTE group (n = 107), snoring (25.2% vs. 6.1%), apnoeas (19.6% vs. 4.3%), restless sleep (31.7% vs. 6.1%), and habitual mouth breathing (35.5% vs. 12.2%, P < 0.05) were significantly more common (P < 0.05) than in the control group (n = 115). The ALTE group also displayed a higher frequency of Angle class II (27.1% vs. 15.7%, P < 0.05), narrow palate (72.9% vs. 51.3%, P < 0.05), and Friedman palate position (grades III-IV) (31.7% vs. 16.6%, P < 0.05) than the control group. Moreover, 38/107 (35.5%) children in the ALTE group had a positive SCR score compared with 14/115 controls (12.2%) (P < 0.05). CONCLUSIONS Pre-school age children with previous ALTE had a higher frequency of sleep disordered breathing and malocclusion phenotypes. The occurrence of ALTEs may be predictive of the development of sleep disordered breathing and highlight the importance of a long-term follow-up. Pediatr Pulmonol. 2016;51:1403-1408. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Jole Rabasco
- Faculty of Medicine and Psychology, Department of Neuroscience, Mental Health and Sense Organs, Pediatric Sleep Disorder Centre, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Alessandro Vigo
- Center for Pediatric Sleep Medicine and SIDS, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Department of Pediatrics, University of Turin, Turin, Italy
| | - Ottavio Vitelli
- Faculty of Medicine and Psychology, Department of Neuroscience, Mental Health and Sense Organs, Pediatric Sleep Disorder Centre, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Silvia Noce
- Center for Pediatric Sleep Medicine and SIDS, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Department of Pediatrics, University of Turin, Turin, Italy
| | - Nicoletta Pietropaoli
- Faculty of Medicine and Psychology, Department of Neuroscience, Mental Health and Sense Organs, Pediatric Sleep Disorder Centre, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Melania Evangelisti
- Faculty of Medicine and Psychology, Department of Neuroscience, Mental Health and Sense Organs, Pediatric Sleep Disorder Centre, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Maria Pia Villa
- Faculty of Medicine and Psychology, Department of Neuroscience, Mental Health and Sense Organs, Pediatric Sleep Disorder Centre, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| |
Collapse
|
17
|
Shawcross A, Murray CS, Goddard N, Gupta R, Watson S, Horsley A. Accurate lung volume measurements in vitro using a novel inert gas washout method suitable for infants. Pediatr Pulmonol 2016; 51:491-7. [PMID: 26623550 DOI: 10.1002/ppul.23348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/04/2015] [Accepted: 11/16/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Multiple breath washout (MBW) in infants presents a number of technical challenges. Conventional MBW is based on simultaneous measurement of flow and gas concentrations. These two signals are aligned and combined to derive expired gas volumes from which lung volumes and measures of ventilation inhomogeneity are calculated. Accuracy of measurement becomes increasingly vulnerable to errors in gas signal alignment at fast respiratory rates. In this paper we describe an alternative method of performing MBW in infants. Expired gas is collected and analyzed to derive functional residual capacity (FRC) and lung clearance index (LCI). This eliminates the need for simultaneous measurement of flow, and integration of flow and gas signals, and significantly reduces deadspace. METHODS A highly accurate lung model incorporating BTPS conditions was used to generate realistic infant breathing parameters: FRC of 100-250 mls with respiratory rate of 20-60 min(-1) . In vitro accuracy of FRC measurement using the novel MBW method was assessed using the model. RESULTS Overall mean error (standard deviation) of FRC measurement was -1.0 (3.3)% with 90% of tests falling within ±5%. DISCUSSION FRC measurement using the novel method has superior accuracy in vitro than previously described systems. By uncoupling the measurement of gas volumes from real-time flow and gas measurement, this system offers an alternative method of MBW which is well suited to infants.
Collapse
Affiliation(s)
- Anna Shawcross
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester and University Hospital of South Manchester, NHS Foundation Trust, Manchester, United Kingdom.,Department of Paediatric Respiratory Medicine, Royal Manchester Children's Hospital, Manchester, United Kingdom.,Manchester Adult Cystic Fibrosis Centre, University Hospital of South Manchester, Manchester, United Kingdom
| | - Clare S Murray
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester and University Hospital of South Manchester, NHS Foundation Trust, Manchester, United Kingdom.,Department of Paediatric Respiratory Medicine, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Nicholas Goddard
- University of Manchester Institute of Biotechnology, Manchester, United Kingdom
| | - Ruchi Gupta
- Department of Chemistry, University of Hull, Manchester, United Kingdom
| | - Stuart Watson
- Department of Medical Physics, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Alexander Horsley
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester and University Hospital of South Manchester, NHS Foundation Trust, Manchester, United Kingdom.,Manchester Adult Cystic Fibrosis Centre, University Hospital of South Manchester, Manchester, United Kingdom
| |
Collapse
|
18
|
Noah TL, Auten R, Schwarze J, Davis S. Pediatric pulmonology year in review 2014: Part 2. Pediatr Pulmonol 2015; 50:1140-6. [PMID: 26193432 DOI: 10.1002/ppul.23252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 06/22/2015] [Accepted: 06/24/2015] [Indexed: 11/07/2022]
Abstract
To better meet the needs of our readership for updated perspectives on the rapidly expanding knowledge in our field, we here summarize the past year's publications in our major topic areas, as well as selected publications in these areas from the core clinical journal literature outside our own pages. This is Part 2 of a series and covers articles on neonatal lung disease, pulmonary physiology, and respiratory infection.
Collapse
Affiliation(s)
- Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Richard Auten
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Jurgen Schwarze
- Department of Child Life and Health, The University of Edinburgh, Edinburgh, UK
| | - Stephanie Davis
- Department of Pediatrics, Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|
19
|
Thunqvist P, Gustafsson P, Norman M, Wickman M, Hallberg J. Lung function at 6 and 18 months after preterm birth in relation to severity of bronchopulmonary dysplasia. Pediatr Pulmonol 2015; 50:978-86. [PMID: 25187077 DOI: 10.1002/ppul.23090] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 06/19/2014] [Accepted: 07/25/2014] [Indexed: 11/11/2022]
Abstract
UNLABELLED Many preterm infants with bronchopulmonary dysplasia (BPD) demonstrate impaired lung function and respiratory symptoms during infancy. The relationships between initial BPD severity, lung function and respiratory morbidity are not fully understood. We aimed to investigate the association between BPD severity and subsequent lung function and whether lung function impairment is related to respiratory morbidity. STUDY DESIGN AND METHODS In this longitudinal cohort study, 55 infants born preterm (23-30 weeks of gestation) with mild or moderate/severe BPD, based on oxygen requirement at 36 gestational weeks, were followed up at 6 and 18 months postnatal age. Respiratory symptoms, such as recurrent or chronic chough and wheeze, were noted and patient records were scrutinized. Lung function was assessed by passive lung mechanics, whole body plethysmography, and tidal and raised volume rapid thoraco-abdominal compression techniques. Results were related to published normative values. RESULTS Besides residual functional capacity (FRC) and respiratory system compliance (Cso ) assessed at 18 months, all measures of lung function were significantly below normative values. Moderate/severe BPD differed significantly from mild BPD only with respect to reduced Cso . At follow-up at 6 and 18 months, participants with respiratory symptoms showed lower; maximal forced expiratory flow at FRC (V'maxFRC) (P = 0.006, P = 0.001), forced mid-expiratory flows (MEF50 ) (P = 0.006, P = 0.048), and Cso (P = 0.004, P = 0.015) as compared to participants without symptoms. CONCLUSIONS In the present study BPD severity did not predict lung function, but may be associated with impaired alveolarization, indicated by reduced Cso . Respiratory morbidity was associated with reduced airway function and respiratory compliance in infancy after preterm birth.
Collapse
Affiliation(s)
- Per Thunqvist
- Sachs' Children's Hospital, Department of Pediatrics, Södersjukhuset, 118 83, Stockholm, Sweden.,Karolinska Institute, Department of Clinical Science and Education, 171 77, Stockholm, Sweden
| | - Per Gustafsson
- The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Central Hospital, Department of Pediatrics, Skövde, Sweden
| | - Mikael Norman
- Karolinska Institute, Department of Clinical Science, Intervention and Technology, 141 86, Stockholm, Sweden
| | - Magnus Wickman
- Sachs' Children's Hospital, Department of Pediatrics, Södersjukhuset, 118 83, Stockholm, Sweden.,Karolinska Institute, Institute of Environmental Medicine, 171 77, Stockholm, Sweden
| | - Jenny Hallberg
- Sachs' Children's Hospital, Department of Pediatrics, Södersjukhuset, 118 83, Stockholm, Sweden.,Karolinska Institute, Institute of Environmental Medicine, 171 77, Stockholm, Sweden
| |
Collapse
|
20
|
Anagnostopoulou P, Yammine S, Schmidt A, Korten I, Kieninger E, Mack I, Trachsel D, Hafen G, Moeller A, Casaulta C, Latzin P. False normal Lung Clearance Index in infants with cystic fibrosis due to software algorithms. Pediatr Pulmonol 2015; 50:970-7. [PMID: 26285162 DOI: 10.1002/ppul.23256] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 06/18/2015] [Accepted: 06/25/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND Lung clearance index (LCI), a marker of ventilation inhomogeneity, is elevated early in children with cystic fibrosis (CF). However, in infants with CF, LCI values are found to be normal, although structural lung abnormalities are often detectable. We hypothesized that this discrepancy is due to inadequate algorithms of the available software package. AIM Our aim was to challenge the validity of these software algorithms. METHODS We compared multiple breath washout (MBW) results of current software algorithms (automatic modus) to refined algorithms (manual modus) in 17 asymptomatic infants with CF, and 24 matched healthy term-born infants. The main difference between these two analysis methods lies in the calculation of the molar mass differences that the system uses to define the completion of the measurement. RESULTS In infants with CF the refined manual modus revealed clearly elevated LCI above 9 in 8 out of 35 measurements (23%), all showing LCI values below 8.3 using the automatic modus (paired t-test comparing the means, P < 0.001). Healthy infants showed normal LCI values using both analysis methods (n = 47, paired t-test, P = 0.79). The most relevant reason for false normal LCI values in infants with CF using the automatic modus was the incorrect recognition of the end-of-test too early during the washout. CONCLUSION We recommend the use of the manual modus for the analysis of MBW outcomes in infants in order to obtain more accurate results. This will allow appropriate use of infant lung function results for clinical and scientific purposes.
Collapse
Affiliation(s)
- Pinelopi Anagnostopoulou
- Division of Respiratory Medicine, Department of Pediatrics, Inselspital and University of Bern, Bern, Switzerland.,3rd Pediatric Department, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Sophie Yammine
- Division of Respiratory Medicine, Department of Pediatrics, Inselspital and University of Bern, Bern, Switzerland
| | - Anne Schmidt
- Division of Respiratory Medicine, Department of Pediatrics, Inselspital and University of Bern, Bern, Switzerland.,University Children's Hospital Basel, UKBB, Basel, Switzerland
| | - Insa Korten
- Division of Respiratory Medicine, Department of Pediatrics, Inselspital and University of Bern, Bern, Switzerland
| | - Elisabeth Kieninger
- Division of Respiratory Medicine, Department of Pediatrics, Inselspital and University of Bern, Bern, Switzerland.,University Children's Hospital Basel, UKBB, Basel, Switzerland
| | - Ines Mack
- Division of Respiratory Medicine, Department of Pediatrics, Inselspital and University of Bern, Bern, Switzerland.,University Children's Hospital Basel, UKBB, Basel, Switzerland
| | - Daniel Trachsel
- University Children's Hospital Basel, UKBB, Basel, Switzerland
| | - Gaudenz Hafen
- Department of Pediatrics, Respiratory Unit, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland
| | | | - Carmen Casaulta
- Division of Respiratory Medicine, Department of Pediatrics, Inselspital and University of Bern, Bern, Switzerland
| | - Philipp Latzin
- Division of Respiratory Medicine, Department of Pediatrics, Inselspital and University of Bern, Bern, Switzerland.,University Children's Hospital Basel, UKBB, Basel, Switzerland
| |
Collapse
|
21
|
Vendettuoli V, Veneroni C, Zannin E, Mercadante D, Matassa P, Pedotti A, Colnaghi M, Dellacà RL, Mosca F. Positional effects on lung mechanics of ventilated preterm infants with acute and chronic lung disease. Pediatr Pulmonol 2015; 50:798-804. [PMID: 24706414 DOI: 10.1002/ppul.23049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 03/07/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND The role of prone position in preterm infants has not been completely clarified. We investigated prone versus supine posture-related changes in respiratory system resistance (Rrs) and reactance (Xrs) measured by the Forced Oscillation Technique (FOT) in mechanically ventilated preterm newborns. METHODS Patients were studied in the supine versus prone positions in random order. Oxygen saturation, transcutaneous partial pressure of oxygen (ptcO2 ), carbon dioxide (ptcCO2 ), Rrs and Xrs were measured in each position. RESULTS Nine patients with respiratory distress syndrome (RDS) and nine with evolving broncho-pulmonary dysplasia (BPD) were studied. Rrs was, on average, 9.8 (1.3, 18.3 as 95%CI) cmH2 O*s/l lower in the prone compared to the supine position (P = 0.02), while no differences in Xrs, ptcO2 , ptcCO2 , and breathing pattern were observed between postures. Only patients with evolving BPD showed a significant reduction of Rrs from 69.0 ± 27.4 to 53.0 ± 16.7 cmH2 O*s/l, P = 0.01. No significant correlations were found between changes in lung mechanics and ptcO2 , ptcCO2 , or breathing pattern. CONCLUSIONS On short-term basis, prone positioning does not offer significant advantages in lung mechanics in mechanically ventilated infants with RDS, while it is associated with lower Rrs values in patients with evolving BPD.
Collapse
Affiliation(s)
- V Vendettuoli
- NICU, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico-Università Degli Studi di Milano, Milan, Italy
| | - C Veneroni
- TBMLab, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milan, Italy
| | - E Zannin
- TBMLab, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milan, Italy
| | - D Mercadante
- NICU, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico-Università Degli Studi di Milano, Milan, Italy
| | - P Matassa
- NICU, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico-Università Degli Studi di Milano, Milan, Italy
| | - A Pedotti
- TBMLab, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milan, Italy
| | - M Colnaghi
- NICU, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico-Università Degli Studi di Milano, Milan, Italy
| | - R L Dellacà
- TBMLab, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milan, Italy
| | - F Mosca
- NICU, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico-Università Degli Studi di Milano, Milan, Italy
| |
Collapse
|
22
|
Hantos Z, Czövek D, Gyurkovits Z, Szabó H, Maár BA, Radics B, Virág K, Makan G, Orvos H, Gingl Z, Sly PD. Assessment of respiratory mechanics with forced oscillations in healthy newborns. Pediatr Pulmonol 2015; 50:344-52. [PMID: 25154334 DOI: 10.1002/ppul.23103] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 05/09/2014] [Accepted: 06/17/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND Lung function data in healthy newborn infants are scarce largely due to lack of suitable techniques, although data for developmental and prenatal exposure studies are much needed. We have modified the forced oscillation technique (FOT) for the measurement of respiratory mechanical impedance (Zrs) in unsedated sleeping infants in the first 3 days of life. METHODS Zrs was measured during 30-s epochs of quiet sleep in term neonates born via spontaneous vaginal delivery with a non-invasive FOT between 8 and 48 Hz. Total respiratory resistance (R), compliance (C) and inertance (I) were obtained by fitting Zrs spectra. Cluster analysis was used to determine a set of minimal Zrs spectra representing optimal respiratory mechanics for each infant. RESULTS Successful measurements were obtained in each of the first 3 days in 30/38 (78.9%) neonates. Group mean (± SD) values of R, C, I, and resonant frequency pooled for the 3 days were 45.9 ± 16.6 hPa s L(-1), 0.97 ± 0.21 ml hPa(-1), 0.082 ± 0.031 hPa s(2) L(-1) and 19.2 ± 3.2 Hz, respectively. Within-session variability represented by coefficient of variation was 5.34 ± 3.18% for R and 13.80 ± 8.57% for C. Greater between-session variability was observed for the individual infants; however, the only statistically significant change over time was a 13% increase in R from day 1 to day 2. Parameter interdependence was significant (r(2) = 0.63) between R and I reflecting the large contribution of the upper airways to the total Zrs. CONCLUSIONS Noninvasive measurement of Zrs can be made in neonates during natural sleep with a high success rate, even in the first hours of life.
Collapse
Affiliation(s)
- Zoltán Hantos
- Department of Medical Physics and Informatics, University of Szeged, Szeged, 6720, Hungary; Queensland Children's Medical Research Institute, University of Queensland, Queensland, Australia
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Callahan P, Pinto SJ, Kurland G, Cain JG, Motoyama EK, Weiner DJ. Dexmedetomidine for infant pulmonary function testing. Pediatr Pulmonol 2015; 50:150-4. [PMID: 25187360 DOI: 10.1002/ppul.23100] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 07/20/2014] [Indexed: 11/11/2022]
Abstract
For the last thirty years, oral chloral hydrate has been used for sedation of infants for lung function testing. Recently, however, availability of chloral hydrate became severely limited in the United States after two manufacturers discontinued manufacturing in 2012. Due to these limitations and the recent and ongoing shortage of chloral hydrate, other medications have been proposed for lung function testing, including midazolam and propofol. Herein, we describe our limited experience using intravenous dexmedetomedine (DMED), a medication thus far described as having minimal effect on pulmonary function or respiratory drive.
Collapse
Affiliation(s)
- Patrick Callahan
- Departments of Anesthesiology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | | | | | | | |
Collapse
|
24
|
Kerby GS, Wagner BD, Popler J, Hay TC, Kopecky C, Wilcox SL, Quinones RR, Giller RH, Accurso FJ, Deterding RR. Abnormal infant pulmonary function in young children with neuroendocrine cell hyperplasia of infancy. Pediatr Pulmonol 2013; 48:1008-15. [PMID: 23169677 DOI: 10.1002/ppul.22718] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 08/27/2012] [Indexed: 11/06/2022]
Abstract
RATIONALE Lung function in children with neuroendocrine cell hyperplasia of infancy (NEHI) and correlations with future clinical outcomes are needed to guide clinical management. OBJECTIVE To compare results of infant pulmonary function tests (IPFTs) in children with NEHI to disease control (DC) subjects and to correlate NEHI IPFTs with future outcomes. METHODS We performed a retrospective, single center study of IPFT in subjects diagnosed by lung biopsy (NEHI) or clinically (NEHI syndrome) and in DC subjects evaluated for cancer or pre-hematopoietic stem cell transplantation (HSCT). Raised volume rapid thoracoabdominal compression (RVRTC) and plethysmography were performed on all infants and evaluated for quality. Standard spirometry measures, room air oxygen saturations (RA O2 sat), and weight percentiles were collected during follow up. MEASUREMENTS AND MAIN RESULTS Fifty-seven IPFTs were performed in 15 NEHI, 22 NEHI syndrome, and 20 DC subjects. RVRTC and FRC measurements were obtained in 85% or more of subjects in all groups. Significant airflow limitation (FEV0.5 P-value ≤ 0.01) and air trapping (FRC P-value ≤ 0.01) were seen in NEHI and NEHI syndrome subjects compared to DCs. No significant correlations were found between IPFT, oxygen use, RA O2 sat, and weight at the time of the IPFTs. Initial FEV0.5 and FRC z-scores correlated with RA O2 sat (r = 0.60 and -0.49) at short-term follow up (6-12 months). Most measurements of RVRTC correlated with FEV1 (n = 5) measured 4-5 years later (r > 0.50). CONCLUSIONS IPFTs in NEHI subjects are feasible, demonstrate significant obstruction and air trapping, and correlate with future RA O2 sat and FEV1 . IPFTs may provide valuable clinical information when caring for NEHI patients. Pediatr Pulmonol. 2013; 48:1008-1015. © 2012 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Gwendolyn S Kerby
- Department of Pediatrics, Section of Pulmonary Medicine, University of Colorado School of Medicine and The Breathing Institute, Children's Hospital Colorado, Aurora, Colorado
| | | | | | | | | | | | | | | | | | | |
Collapse
|