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Bronchopulmonary dysplasia: Clinical grading in relation to ventilation/perfusion mismatch measured by single photon emission computed tomography
Author(s) -
Kjellberg Malin,
Björkman Karin,
Rohdin Malin,
SanchezCrespo Alejandro,
Jonsson Baldvin
Publication year - 2013
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.22751
Subject(s) - medicine , bronchopulmonary dysplasia , single photon emission computed tomography , ventilation (architecture) , population , perfusion , mean airway pressure , grading (engineering) , nuclear medicine , mechanical ventilation , airway , continuous positive airway pressure , anesthesia , cardiology , gestational age , pregnancy , mechanical engineering , genetics , civil engineering , obstructive sleep apnea , environmental health , engineering , biology
Bronchopulmonary dysplasia (BPD) is a significant cause of morbidity in the preterm population. Clinical severity grading based on the need for supplemental oxygen and/or need for positive airway pressure at 36 weeks postmenstrual age does not yield reproducible predictive values for later pulmonary morbidity. Single photon emission computed tomography (SPECT) was used to measure the distribution of lung ventilation (V) and perfusion (Q) in 30 BPD preterm infants at a median age of 37 weeks postmenstrual age. The V and Q were traced with 5 MBq Technegas and Technetium‐labeled albumin macro aggregates, respectively, and the V/Q match–mismatch was used to quantify the extent of lung function impairment. The latter was then compared with the clinical severity grading at 36 weeks, and time spent on mechanical ventilation, continuous positive airway pressure (CPAP) and supplemental oxygen. Of those with mild and moderate BPD 3/9 and 3/11 patients, respectively, showed significant V/Q mismatches. By contrast, 4/10 patients with severe BPD showed a satisfactory V/Q matching distribution. An unsatisfactory V/Q match was not correlated with time spent on supplemental oxygen or CPAP, but was significantly negatively correlated with time spent on mechanical ventilation. SPECT provides unique additional information about regional lung function. The results suggest that the current clinical severity grading can be improved and/or complemented with SPECT. Pediatr Pulmonol. 2013; 48:1206–1213. © 2013 Wiley Periodicals, Inc.