Variability of Tidal Breathing Parameters in Preterm Infants and Associations with Respiratory Morbidity during Infancy: A Cohort Study

Usemann, Jakob; Suter, Andrea; Zannin, Emanuela; Proietti, Elena; Fouzas, Sotirios; Schulzke, Sven; Latzin, Philipp; Frey, Urs; Fuchs, Oliver; Korten, Insa; Anagnostopoulou, Pinelopi; Gorlanova, Olga

doi:10.1016/j.jpeds.2018.10.002

Cited by 22 publications

(29 citation statements)

References 39 publications

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“…In this observational study, the results indicate reduced TBFV variability in infants with wheeze, which agrees with studies in adults with asthma [ 7 ] and COPD [ 8 ], children with asthma [ 4 , 9 ], and infants with bronchopulmonary dysplasia [ 10 ]. This reduced variation in TBFV pattern, which has been attributed to reduced adaptability of the respiratory system during mechanical loading by airway obstruction [ 7 ], should be distinguished from the other phenomenon of increased variation in respiratory impedance or diurnal peak flow commonly known as characteristics of asthma [ 15 ].…”

supporting

confidence: 90%

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Expiratory variability index is associated with asthma risk, wheeze and lung function in infants with recurrent respiratory symptoms

Seppä¹,

Gracia‐Tabuenca

Kotaniemi‐Syrjänen

et al. 2020

ERJ Open Res

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supporting

confidence: 90%

“…TBFV variability has been expressed in several ways [ 4 , 5 , 7 – 10 ]. The recently introduced expiratory variability index (EVI) is derived by calculating correlations between expiratory TBFV curves, with low EVI indicating reduced variability of the curve shapes [ 6 ].…”

mentioning

confidence: 99%

Expiratory variability index is associated with asthma risk, wheeze and lung function in infants with recurrent respiratory symptoms

Seppä¹,

Gracia‐Tabuenca

Kotaniemi‐Syrjänen

et al. 2020

ERJ Open Res

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“…Variability in breathing has been examined in infants receiving different types of respiratory support. 23 , 26 , 27 , 44 In this study, changes in neural breathing variability were observed from MV to ETT-CPAP and were characterized by an increased variability in breath depth and decreased variability in breath times. In other words, infants responded to the 5-min ETT-CPAP by breathing deeper and more constantly, and with increased variability of breathing efforts.…”

Section: Discussionmentioning

confidence: 73%

“…Differences in respiratory variability between extubation outcomes 28 and respiratory morbidities 26 , 27 have been previously described during MV weaning, and abnormal variability (too high or too low) has been associated with worse outcomes. In this study, infants that went on to fail their extubation showed increased variability of some parameters during ETT-CPAP.…”

Section: Discussionmentioning

confidence: 74%

“…Breathing, under normal conditions, is a highly variable physiological process representing adaptation of the respiratory control systems; most importantly, alterations in respiratory variability have been demonstrated in response to increases in respiratory mechanical loading, 23 – 25 and in relation to respiratory morbidities. 26 , 27 Differences in respiratory variability have also been found between infants who succeed or fail extubation, 28 but it was calculated from analysis of respiratory inductive plethysmography signals or ventilator measurements, which are subject to artifacts. Therefore, the primary objective of this study was to describe diaphragmatic activity and neural breathing variability during a 5-min ETT-CPAP period in extremely preterm infants undergoing their first extubation attempt.…”

Section: Introductionmentioning

confidence: 99%

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Diaphragmatic activity and neural breathing variability during a 5-min endotracheal continuous positive airway pressure trial in extremely preterm infants

et al. 2020

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Background Extremely preterm infants are often exposed to endotracheal tube continuous positive airway pressure (ETT-CPAP) trials to assess extubation readiness. The effects of ETT-CPAP trial on their diaphragmatic activity (Edi) and breathing variability is unknown. Methods Prospective observational study enrolling infants with birth weight ≤1250 g undergoing their first extubation attempt. Diaphragmatic activity, expressed as the absolute minimum (Edi min) and maximum values (Edi max), area under the Edi signal, and breath-by-breath analyses for breath areas, amplitudes, widths, and neural inspiratory and expiratory times, were analyzed during mechanical ventilation (MV) and ETT-CPAP. Neural breathing variability of each of these parameters was also calculated and compared between MV and ETT-CPAP. Results Thirteen infants with median (interquartile range) birth weight of 800 g [610–920] and gestational age of 25.4 weeks [24.4–26.3] were included. Diaphragmatic activity significantly increased during ETT-CPAP when compared to MV:Edi max (44.2 vs. 38.1 μV), breath area (449 vs. 312 μV·s), and amplitude (10.12 vs. 7.46 μV). Neural breathing variability during ETT-CPAP was characterized by increased variability for amplitude and area under the breath, and decreased for breath time and width. Conclusions A 5-min ETT-CPAP in extremely preterm infants undergoing extubation imposed significant respiratory load with changes in respiratory variability. Impact ETT-CPAP trials are often used to assess extubation readiness in extremely preterm infants, but its effects upon their respiratory system are not well known. Diaphragmatic activity analysis demonstrated that these infants are able to mount an important response to a short trial. A 5-min trial imposed a significant respiratory load evidenced by increased diaphragmatic activity and changes in breathing variability. Differences in breathing variability were observed between successful and failed extubations, which should be explored further in extubation readiness investigations. This type of trial cannot be recommended for preterm infants in clinical practice until clear standards and accuracy are established.

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Cord blood group 2 innate lymphoid cells are associated with lung function at 6 weeks of age

et al. 2021

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Objective. Offspring born to mothers with asthma in pregnancy are known to have lower lung function which tracks with age. Human group 2 innate lymphoid cells (ILC2) accumulate in foetal lungs, at 10-fold higher levels compared to adult lungs. However, there are no data on foetal ILC2 numbers and the association with respiratory health outcomes such as lung function in early life. We aimed to investigate cord blood immune cell populations from babies born to mothers with asthma in pregnancy. Methods. Cord blood from babies born to asthmatic mothers was collected, and cells were stained in whole cord blood. Analyses were done using traditional gating approaches and computational methodologies (t-distributed stochastic neighbour embedding and PhenoGraph algorithms). At 6 weeks of age, the time to peak tidal expiratory flow as a percentage of total expiratory flow time (tPTEF/tE%) was determined as well as Lung Clearance Index (LCI), during quiet natural sleep. Results. Of 110 eligible infants (March 2017 to November 2019), 91 were successfully immunophenotyped (82.7%). Lung function was attempted in 61 infants (67.0%), and 43 of those infants (70.5% of attempted) had technically acceptable tPTEF/tE% measurements. Thirty-four infants (55.7% of attempted) had acceptable LCI measurements. Foetal ILC2 numbers with increased expression of chemoattractant receptorhomologous molecule (CRTh2), characterised by two distinct analysis methodologies, were associated with poorer infant lung function at 6 weeks of age." Conclusion. Foetal immune responses may be a surrogate variable for or directly influence lung function outcomes in early life.

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Variability of Tidal Breathing Parameters in Preterm Infants and Associations with Respiratory Morbidity during Infancy: A Cohort Study

Cited by 22 publications

References 39 publications

Expiratory variability index is associated with asthma risk, wheeze and lung function in infants with recurrent respiratory symptoms

Expiratory variability index is associated with asthma risk, wheeze and lung function in infants with recurrent respiratory symptoms

Diaphragmatic activity and neural breathing variability during a 5-min endotracheal continuous positive airway pressure trial in extremely preterm infants

Cord blood group 2 innate lymphoid cells are associated with lung function at 6 weeks of age

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