Effect of maturity and infection on the rate of relaxation of the respiratory muscles in ventilated, newborn infants

Dassios, Theodore; Kaltsogianni, Ourania; Dixon, Paul; Greenough, Anne

doi:10.1111/apa.14188

Cited by 7 publications

(5 citation statements)

References 20 publications

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“…The next line of research might thus be a randomised study where infants with PDA are assigned to extubation after either diaphragmatic assessment or clinical decision alone, and evaluate the predictive ability of ultrasound to differentiate successful extubation. We did not assess in our study other factors that might influence respiratory muscle function in the newborn such as systemic or respiratory infection ( 23 , 24 ) or respiratory mechanics ( 25 ). The diagnosis of infection, however, is often elusive in neonatal intensive care where unwell and premature infants with multiple comorbidities often receive broad spectrum antibiotics, while the incidence of true culture-positive sepsis is below one percent ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Diaphragmatic ultrasound and patent ductus arteriosus in the newborn: A retrospective case series

Dassios

Thodika²,

Nanjundappa³

et al. 2023

Front. Pediatr.

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BackgroundPatent ductus arteriosus (PDA) and diaphragmatic dysfunction are frequently seen in newborn infants but their relationship remains unknown. We aimed to use point of care ultrasound to compare diaphragmatic kinetics in infants with a PDA compared to in those without a PDA.MethodsM-mode ultrasonography was used to measure the mean inspiratory velocity (VI) in newborn infants with and without a haemodynamically significant PDA admitted in the Neonatal Unit at King's College Hospital during a three month period.ResultsSeventeen diaphragmatic ultrasound studies were reviewed from 14 infants with a median (IQR) gestational age of 26.1 (25.8–30.6) weeks, birth weight of 780 (660–1385) gr at a postnatal age of 18 (14–34) days. Eight scans had evidence of a PDA. The median (IQR) VI was significantly lower in scans with a PDA [1.01 (0.78–1.86) cm/s] compared to the ones without a PDA [3.21 (2.80–3.59) cm/s, p < 0.001]. The median (IQR) gestational age was lower in infants with a PDA [25.8 (25.6–27.3) weeks] compared to infants without a PDA [29.0 (26.1–35.1) weeks, p = 0.007]. Using multivariable linear regression analysis the VI was independently associated with a PDA (adjusted p < 0.001) but not with the gestational age (adjusted p = 0.659).ConclusionsPatent ductus arteriosus was associated with a lower mean inspiratory velocity in neonates and this effect was independent of gestational age.

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Section: Discussionmentioning

confidence: 99%

Diaphragmatic ultrasound and patent ductus arteriosus in the newborn: A retrospective case series

Dassios

Thodika²,

Nanjundappa³

et al. 2023

Front. Pediatr.

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“…1 and 2 ). Therefore, the PTIdi thresholds may vary in different clinical settings or perinatal exposures (e.g., reduced tissue perfusion, hypoxemia, systemic inflammation, administration of corticosteroids) [ 2 , 8 – 11 , 28 ]. In any case, increased PTIdi values signify that the diaphragm is at a relative mechanical disadvantage and presents a lower force-generating capability over time, especially under conditions of increased inspiratory load [ 2 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…The structural and functional immaturity of the muscle is mainly determined by gestational age (GA) [ 2 , 6 , 7 ]. Moreover, conditions commonly related to prematurity, such as prolonged mechanical ventilation, bronchopulmonary dysplasia (BPD) and perinatal infections [ 8 – 11 ], may further affect the normal growth and maturation of the diaphragm [ 2 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Diaphragmatic muscle function in term and preterm infants

Fouzas,

Vervenioti,

Tsintoni

et al. 2023

Eur J Pediatr

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We aimed to assess the determinants of diaphragmatic function in term and preterm infants. 149 infants (56 term; 93 preterm, of whom 14 were diagnosed with bronchopulmonary dysplasia—BPD) were studied before discharge. Diaphragmatic function was assessed by measurement of the maximum transdiaphragmatic pressure (Pdimax)—a measure of diaphragmatic strength, and the pressure–time index of the diaphragm (PTIdi)—a measure of the load-to-capacity ratio of the diaphragm. The Pdimax was higher in term than preterm infants without BPD (90.1 ± 16.3 vs 81.1 ± 11.8 cmH2O; P = 0.001). Term-born infants also had lower PTIdi compared to preterms without BPD (0.052 ± 0.014 vs 0.060 ± 0.017; P = 0.006). In term and preterm infants without BPD, GA was the most significant predictor of Pdimax and PTIdi, independently of the duration of mechanical ventilation and oxygen support. In infants with GA < 32 weeks (n = 30), the Pdimax was higher in infants without BPD compared to those with BPD (76.1 ± 11.1 vs 65.2 ± 11.9 cmH2O; P = 0.015). Preterms without BPD also had lower PTIdi compared to those with BPD (0.069 ± 0.016 vs 0.109 ± 0.017; P < 0.001). In this subgroup, GA was the only significant independent determinant of Pdimax, while BPD and the GA were significant determinants of the PTIdi. Conclusions: Preterm infants present lower diaphragmatic strength and impaired ability to sustain the generated force over time, which renders them prone to diaphragmatic fatigue. In very preterm infants, BPD may further aggravate diaphragmatic function. What is Known:• The diaphragm of preterm infants has limited capacity to undertake the work of breathing effectively.• The maximum transdiaphragmatic pressure (a measure of diaphragmatic strength) and the pressure–time index of the diaphragm (a measure of the load-to-capacity ratio of the muscle) have not been extensively assessed in small infants. What is New:• Preterm infants have lower diaphragmatic strength and impaired ability to sustain the generated force over time, which renders them prone to diaphragmatic fatigue.• In very preterm infants, bronchopulmonary dysplasia may further impair diaphragmatic function.

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“…Such parameters are the functional integrity of the respiratory muscles 19 and the presence of systemic or respiratory infection. 20 We cannot thus advocate that knowledge of the V T can inform the clinician of the likely outcome of extubation nor that ventilating with higher V T will increase the chances of successful extubation. We can, however, highlight that extubating from low unadjusted V T s is associated with extubation failure.…”

Section: Discussionmentioning

confidence: 99%

Tidal Volumes and Outcome of Extubation in Mechanically Ventilated Premature Infants

Dassios

Williams²,

Ambulkar

et al. 2019

Am J Perinatol

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Objectives To compare the adjusted and unadjusted-for-weight tidal volume (VT) in ventilated prematurely born infants who were successfully extubated compared with the ones who failed extubation and explore the ability of VT to predict successful extubation. Study Design This is a two-center, prospective, observational, cohort study of ventilated infants born <32 weeks of gestational age (GA) at King's College Hospital and St George's University Hospital, London, United Kingdom between February and September 2018. Expiratory VT was recorded before extubation, and extubation was considered successful if the infants were not reintubated within 72 hours. Results Fifty-six (29 male) infants with a median (interquartile range) GA of 26 (25–29) weeks were studied. The infants who successfully extubated (N = 36) had a higher GA (27 [25–30] weeks) and VT (7.2 [4.8–9.5] mL) compared with the GA (25 [24–26] weeks) and VT (4.3 [4.0–5.5] mL) of the infants who failed extubation (p = 0.002 and p = 0.001, respectively). VT/kg was not different in infants who successfully extubated compared with the ones who failed extubation (p = 0.643). Following multivariate regression, VT was associated with extubation success (adjusted p = 0.022) and GA was not (adjusted p = 0.167). A VT > 4.5 mL predicted successful extubation with 82% sensitivity and 58% specificity (area under the curve = 0.786). Conclusion Successful extubation was associated with higher unadjusted-for-weight VTs compared with failed extubation, and unadjusted VT predicted extubation outcome with moderate sensitivity and specificity.

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Effect of maturity and infection on the rate of relaxation of the respiratory muscles in ventilated, newborn infants

Abstract: Respiratory muscle function in ventilated newborns is negatively affected by prematurity and previous systemic or respiratory infection.

Cited by 7 publications

References 20 publications

Diaphragmatic ultrasound and patent ductus arteriosus in the newborn: A retrospective case series

Diaphragmatic ultrasound and patent ductus arteriosus in the newborn: A retrospective case series

Diaphragmatic muscle function in term and preterm infants

Tidal Volumes and Outcome of Extubation in Mechanically Ventilated Premature Infants

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