Early prediction of chronic lung disease by pulmonary function testing

Goldman, Michael; Gerhardt, M.D. Tilo; Sonni, M.D. Rajeswari; Feller, Rosalyn; Hehre, B.S. Dorothy; Tapia, Milagritos D.; Bancalari, M.D. Eduardo

doi:10.1016/s0022-3476(83)80202-9

Cited by 99 publications

(37 citation statements)

References 16 publications

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“…Most studies on resistance of the respiratory system in mechanically ventilated infants with IRDS show increased values as compared with healthy preterms. The mean pulmonary resistance value of the infants in our study was 95 cm H>O/L/s, which was lower than values in other studies (Tables 3 and 4) (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). It is, however, difficult to make comparisons with data from nonintubated spontaneously breathing infants and mechanically ventilated infants as well as with different materials of mechanically ventilated infants for several reasons.…”

Section: Discussioncontrasting

confidence: 75%

Lung Volume, Gas Mixing, and Mechanics of Breathing in Mechanically Ventilated Very Low Birth Weight Infants with Idiopathic Respiratory Distress Syndrome

et al. 1991

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ABSTRACT. We assessed pulmonary function in 14 mechanically ventilated newborn very low birth weight infants with idiopathic respiratory distress syndrome by means of a face-out, volume displacement body plethysmograph and nitrogen washout analyses. Specially designed computer programs were used for calculations of lung volumes, ventilation, gas mixing efficiency, and mechanical parameters. In addition to very low compliance and moderately elevated resistance of the respiratory system, there were considerably impaired gas mixing efficiency and low functional residual capacity (FRC) For methodologic reasons, lung function studies in newborn infants with IRDS have largely been focused on lung mechanics. Using applied methods makes it possible to obtain a more comprehensive picture of ventilatory conditions, even in very premature, severely affected infants. To further clarify the pathophysiology of IRDS under conditions of mechanical ventilation in this group of infants, we assessed lung volume, alveolar ventilation, gas mixing efficiency, and lung mechanics in mechanically ventilated infants with birth weights below 1500 g. MATERIALS AND METHODSWe studied 14 very low birth weight infants with IRDS during intermittent positive pressure ventilation within 5 d (range 0-5 d) of birth. Six of the infants were boys and eight were girls. Median birth weight was 1.29 kg (range 1.00-1.50 kg) and median gestational age was 29 wk (range 26-33 wk). Informed consent was obtained from the parents of each infant before the procedure was camed out, and the study was approved by the ethics committee of Goteborg University.Maternal history included preeclampsia in six cases and abruption of the placenta in three cases. One infant was a twin. Twelve infants were delivered by cesarean section. Apgar scores were below 5 at 1 min in seven infants and below 7 at 5 min in seven infants. All infants were flushed with oxygen immediately after birth, and nine were also ventilated using a mask. Ten of the infants with adequate spontaneous respiration were treated with continuous positive airway pressure by nasal prongs within 4 h of birth, and the other four were intubated and ventilated within a few minutes of birth. Mechanical ventilation was started within 27 h in all infants. The pulmonary disease was classified as IRDS in all infants (1). All initial radiographs showed a reticulogranular pattern, and no infant had positive blood cultures or hematologic signs of infection.The following guidelines for mechanical ventilation of very low birth weight infants with IRDS were used in the intensive care unit: Nasal intubation with uncuffed endotracheal tubes 2.5-3.0 (Portex LTD, Hythe, Kent, UK) was performed. A Sechrist Infant Ventilator 400 B (Sechrist Industries Inc., Anaheim, CA) was connected to the endotracheal tube. The breathing gas was humidified and heated with a humidifier (Fisher and Paykel, Auckland, New Zealand). Initial ventilator settings were: respiratory rate 60 breathslmin, inspiratory/expiratory ratio 112, PIP 25-30 cm H20,...

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Section: Discussioncontrasting

confidence: 75%

Lung Volume, Gas Mixing, and Mechanics of Breathing in Mechanically Ventilated Very Low Birth Weight Infants with Idiopathic Respiratory Distress Syndrome

et al. 1991

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“…Moreover, an abnormal pulmonary vasculature has been reported as an important component of BPD (9,10). The absence of microvascular changes in HCA patients who subsequently will not develop BPD confirms the multifactorial pathogenesis of the disease where other factors may also play a role, including mechanical trauma and oxygen toxicity (3)(4)(5), pulmonary edema associated with patent ductus arteriosus and/or excess fluid administration (21), nutritional deficiencies (22), a predisposition to airway reactivity (23), early adrenal insufficiency (24), and di-(2-ethylhexyl)-phthalate release from endotracheal tubes (6,7). Recent preliminary research indicates a reduced expression of vascular endothelial growth factor receptor 1 (25) in fetal capillaries in preterm placentas with chorioamnionitis, which is in line with the findings of altered vascularization in infants who have HCA and subsequently develop BPD.…”

Section: Discussionmentioning

confidence: 90%

Oral Mucosal Microvascular Abnormalities: An Early Marker of Bronchopulmonary Dysplasia

et al. 2004

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An abnormal pulmonary vasculature has been reported as an important component of bronchopulmonary dysplasia (BPD). We tested the hypothesis of an early abnormal vascular network pattern in infants with BPD. Fifteen infants with BPD (nine boys and six girls; gestational age 27.5 Ϯ 2.0 wk; birth weight 850 Ϯ 125 g) and 15 sex-and gestational age-matched infants (nine boys and six girls; gestational age 27.6 Ϯ 2.6 wk; birth weight 865 Ϯ 135 g) were examined on postnatal days 1 and 28. BPD infants showed a significantly higher prevalence of histologic chorioamnionitis (p ϭ 0.009), as well as higher intubation duration (p ϭ 0.0004), oxygen supplementation (p Ͻ 0.0001), and initial illness severity (p ϭ 0.0002) than the BPD-negative population. The lower gingival and vestibular oral mucosa was chosen as the study area. The blood vessel area was determined, and the oral vascular networks were characterized by analyzing their complexity ( Bronchopulmonary dysplasia (BPD) remains an important cause of mortality and morbidity in preterm infants. BPD is infrequent in infants with birth weight Ͼ1200 g or with gestation Ͼ30 wk, whereas among infants with birth weight Ͻ1000 g, a prevalence of~30% has been reported (1,2). To date, the pathogenesis of BPD remains unclear. Besides the well-known oxygen toxicity, volutrauma, and mechanical injury mechanisms (3), antenatal or postnatal inflammatory response (4,5) and leakage of plasticizers from endotracheal tubes (6,7) have been more recently associated with injury to the immature lung and/or the development of BPD. Delayed and disturbed formation of the terminal respiratory units have been reported in BPD (8), together with a disordered vascular development and a decreased production of angiogenic factors (9,10). In the past two decades it has been realized that many biologic systems have no characteristic length scale, thus having fractal or self-affine properties (11). Fractals are of great value in biology, where surface phenomena are of crucial importance and a number of complex anatomic structures, including arterial and venous trees, also display fractal-like geometry. We tested the hypothesis of an abnormal mucosa vascularization and network pattern in BPD by using fractal analysis. METHODSFifteen consecutive preterm infants with BPD (nine boys and six girls; gestational age 27.5 Ϯ 2.0 wk; birth weight 850 Ϯ 125 g) were examined, together with 15 sex-and gestational

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“…In this study, we used the same protocol for all infants and only deemed equilibration of the helium to have occurred if there was no change in the helium concentration over a 15-sec period. The infants included in this study were examined in the first days after birth, but even at that time infants who develop BPD have a high respiratory resistance, [20][21][22] although this is not a consistent finding. 23,24 The measurement of FRC by whole body plethysmography (FRC pleth ) is not subject to errors related to ventilation inhomogeneity or gas trapping and neither is the CXR thoracic area.…”

Section: Discussionmentioning

confidence: 99%

Chest radiograph thoracic areas and lung volumes in infants developing bronchopulmonary dysplasia

May

Prendergast

Salman

et al. 2008

Pediatric Pulmonology

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Summary. Objectives: To determine whether chest radiograph (CXR) thoracic areas and lung volumes differed between infants who did and did not develop BPD and according to the severity of BPD developed. Working Hypothesis: Infants developing BPD, particularly if moderate or severe, would have low CXR thoracic areas and lung volumes in the perinatal period. Study Design: Prospective study. Patient-Subject Selection: 53 infants with a median gestational age of 28 (range 24-32) weeks. Methodology: CXR thoracic areas were calculated using a Picture Archiving and Communicating System (PACS) and lung volume assessed by measurement of functional residual capacity (FRC) in the first 72 hr after birth. BPD was diagnosed if the infants were oxygen dependent beyond 28 days, mild BPD in infants no longer oxygen dependent at 36 weeks postmenstrual age (PMA) and moderate/severe BPD in infants who required supplementary oxygen with or without respiratory support at 36 weeks PMA. Results: Thirty two infants developed BPD, 21 had moderate/severe BPD. The median CXR thoracic areas were higher (P < 0.0001) and FRCs were lower (P < 0.0001) in the BPD compared to no BPD infants. The median CXR thoracic areas of the moderate/severe group (P < 0.001) and the mild group (P < 0.05) were greater than that of the no BPD group and the median FRC of the moderate/severe BPD group was lower than the no BPD group (<0.001) and the mild BPD group (P < 0.05). Conclusion: These results highlight that in the perinatal period infants developing BPD, particularly if moderate/severe, have low functional lung volumes and may have gas trapping, which likely reflects ventilation inhomogeneity.

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Early prediction of chronic lung disease by pulmonary function testing

Cited by 99 publications

References 16 publications

Lung Volume, Gas Mixing, and Mechanics of Breathing in Mechanically Ventilated Very Low Birth Weight Infants with Idiopathic Respiratory Distress Syndrome

Lung Volume, Gas Mixing, and Mechanics of Breathing in Mechanically Ventilated Very Low Birth Weight Infants with Idiopathic Respiratory Distress Syndrome

Oral Mucosal Microvascular Abnormalities: An Early Marker of Bronchopulmonary Dysplasia

Chest radiograph thoracic areas and lung volumes in infants developing bronchopulmonary dysplasia

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