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Differential effects of immaturity and neonatal lung disease on the lung function of very low birth weight infants at 48–52 postconceptional weeks
Author(s) -
Schmalisch Gerd,
Wilitzki Silke,
Roehr Charles C.,
Proquitté Hans,
Bührer Christoph
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.22770
Subject(s) - medicine , lung volumes , lung , respiratory physiology , plethysmograph , birth weight , respiratory system , gestational age , pulmonary compliance , ventilation (architecture) , mechanical ventilation , tidal volume , respiratory disease , cardiology , anesthesia , pregnancy , mechanical engineering , biology , engineering , genetics
Background The pathogenesis of chronic lung disease of prematurity involves maturational arrest and neonatal lung disease (NLD) followed by mechanical ventilation (MV). However, the effect of these factors on postnatal lung function is not well established. Therefore, the aim of this study was to examine the differential effects of immaturity and NLD requiring MV on lung function test (LFT) parameters within 4 months after discharge. Patients and Methods A total of 386 very low birth weight (VLBW) infants (birth weight <1,500 g) were examined at a median postmenstrual age of 49 weeks. Two hundred twenty‐six infants (59%) were born before the 28th week of gestation, and 247 infants (64%) had NLD requiring invasive MV. LFTs included tidal breathing measurements, measurement of respiratory mechanics assessed by occlusion test, body plethysmography, SF6 multiple breath washout, forced expiratory flow ( V ma x FRC′ ) by rapid thoraco‐abdominal compression technique, end‐expiratory CO 2 (P et CO 2 ), exhaled NO (FeNO), and arterialized capillary blood gas analysis. Main Results Multivariate analysis indicated that severe immaturity was mainly associated with changes in the breathing pattern (reduced tidal volume ( P = 0.003) and increased respiratory rate ( P = 0.03)), a reducedV ma x FRC′( P = 0.004) and lower respiratory compliance ( P < 0.001). NLD requiring MV, but not immaturity, was significantly and independently associated with increased respiratory and airway resistances (both P = 0.003), reduced FRC SF6 ( P = 0.03), increased P et CO 2 ( P = 0.019) and lower FeNO ( P < 0.001). Both immaturity and NLD requiring MV caused a lower paO 2 ( P < 0.001) and higher a paCO 2 . Conclusions Lung function after discharge of VLBW infants is differentially affected by both immaturity and NLD requiring MV. With increasing prematurity, intubated and mechanically ventilated infants are at increased risk of developing impaired lung function which can be detected by LFT. Pediatr Pulmonol. 2013; 48:1214–1223. © 2013 Wiley Periodicals, Inc.