Pulmonary function until two years of life in infants with bronchopulmonary dysplasia.

Abstract

To evaluate the physiologic course of pulmonary function in infants with bronchopulmonary dysplasia (BPD) weighing less than 1,250 g at birth, 24 infants with BPD underwent serial pulmonary function evaluations from birth until 2 yr of age. All infants were intubated at birth and the mean duration of mechanical ventilation was 38 +/- 4 d. Passive respiratory system compliance (Crs) and resistance (Rrs) were measured between 10 and 20 d of life during mechanical ventilation. Thereafter pulmonary mechanics and functional residual capacity (FRC) were evaluated at 3, 6, 9, 12, and 24 mo of postnatal age. Forced expiratory flow (Vmax,FRC) was measured at 2 yr of age. A severe alteration on Crs (50% of predicted) was found during the acute phase of BPD, associated with abnormal values of Rrs. A progressive improvement (ANOVA, p < 0.0001) occurred in the first year of life and, at 24 mo of age, Crs and Rrs reached the range of normalcy. FRC value was 86 +/- 7.5% of predicted at 3 mo and gradually increased to a mean value of 115 +/- 5% of predicted at 2 yr of age. In spite of the good resistance time course over the 2-yr evaluation, less favorable data of Vmax,FRC were found with individual values reduced more than 40% of predicted values in 70% of the children. In conclusion, although pulmonary mechanics of BPD survivors improves during the first years of life, reaching the range of normal values, at 2 yr of age they still present a substantial airway function impairment as revealed by the low forced expiratory flows.

Lung Function Tests in Neonates and Infants with Chronic Lung Disease of Infancy: Functional Residual Capacity

“…In established CLDI, FRC around term equivalent is significantly reduced compared with normative data from healthy term control infants 99,100,102 or preterm controls without clinically evident neonatal pulmonary compromise. 35,58,68 During the first 2 years of life, a relative increase in FRC was observed, using gas dilution techniques.…”

“…35,58,68 During the first 2 years of life, a relative increase in FRC was observed, using gas dilution techniques. 99,100 Comparison of FRC pleth and FRC N2 14 in CLDI infants suggests that significant gas-trapping may occur in these infants, although the magnitude of the difference in FRC between methods needs to be interpreted cautiously, due to potential methodological limitations in the presence of marked airway obstruction.…”

Impact of bronchopulmonary dysplasia on pulmonary function during childhood: a systematic review

“…Of the 22 articles included (table 1), 12 assessed children with a history of BPD at different moments (longitudinal) [7][8][9][10][11][12][13][14][15][16]27,28 and the maximum follow-up was the interval between the neonatal hospital stay and five years of life. The remaining ten reviewed studies performed pulmonary function testing in one single moment (transversal).…”

“…Currently, pulmonary function testing in early childhood, i.e., the time period ranging from 0 to 6 years including infants and preschoolers, can be performed by examinations, such as rapid chest compression, single breath occlusion, plethysmography and helium dilution 6 . Studies indicate that infants with BPD show compromised pulmonary function in the first years of life, with significant expiratory flow limitation, namely, forced expiratory volume in one second (FEV1), mean forced expiratory flow (FEF25-75%), as well as reduced pulmonary compliance, increased pulmonary resistance, higher respiratory rate, reduced functional residual capacity (FRC) and residual volume [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] . These results are characteristics of ventilatory and functional changes, the knowledge of which may provide a better understanding of the disease and, consequently, improve treatment and preventive strategies to manage the disease.…”

Seguimiento neumológico de los niños con displasia broncopulmonar al alta de la Unidad de Cuidados Intensivos Neonatal. Parte 1: Epidemiología, fisiopatología y clínica

“…Algunos estudios longitudinales muestran que en los lactantes con DBP, la distensibilidad pulmonar mejora con el tiempo, mientras que la disminución de los flujos espiratorios puede persistir durante toda la infancia. 20,22 En los prematuros con compromiso predominante del desarrollo alveolar, se observó una disminución de la superficie de intercambio gaseoso. Esta última fue evaluada por el método de difusión de monóxido de carbono, que puso de manifiesto la afectación parenquimatosa en los prematuros extremos.…”