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Physiologic findings in children previously ventilator dependent at home due to bronchopulmonary dysplasia
Author(s) -
Cristea A. Ioana,
Ackerman Veda L.,
Swigonski Nancy L.,
Yu Zhangsheng,
Slaven James E.,
Davis Stephanie D.
Publication year - 2015
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.23129
Subject(s) - medicine , bronchopulmonary dysplasia , spirometry , airway obstruction , cohort , pediatrics , airway , surgery , gestational age , asthma , pregnancy , genetics , biology
Summary Introduction Bronchopulmonary dysplasia (BPD) is the primary respiratory complication of premature birth. Some preterm newborns develop chronic respiratory failure, requiring home ventilator support. While physiologic measures have been described for prematurely born children, little is known about spirometric indices in patients with severe BPD who were previously ventilator dependent at home. Methods We retrospectively reviewed medical charts of patients with severe BPD who were ventilator dependent at home. We excluded patients with other comorbidities that could contribute to the severity of BPD. Spirometry was performed when the patient was able to follow commands. Results Between 1984 and 2012, within our severe BPD cohort who previously required home ventilator support, 19 patients were able to perform reproducible spirometry meeting ATS/ERS acceptability criteria. Ten (52.6%) were females, 13 (68.4%) were Caucasians. Mean age at liberation from ventilation was 2.4 years (C.I. 2.0, 2.9) and at decannulation was 3.5 years (C.I. 2.9, 4.0); median age at first reproducible spirometry measurement was 6.6 years (IQR: 4.9, 8.3). Spirometry results revealed significant airway obstruction, as demonstrated by Z‐scores values of −1.5 (C.I. −2.5, −0.4) for FVC, −2.7 (C.I. −3.3, −1.9) for FEV 1 , and −3.6 (C.I. −4.3, −2.9) for FEF 25–75 . More so, serial spirometric measurements' slopes revealed that the airway obstruction remained static over time (FEV 1 slope: −0.07, P ‐value: 0.2624; FVC slope: −0.01, P ‐value: 0.9064; and FEF 25–75 : 0.0, P ‐value: 0.8532). Conclusions Extreme prematurity associated with severe BPD requiring home ventilator support carries significant risks of morbidity. These patients had substantially diminished respiratory function reflecting airflow abnormalities that remained static over time. Pediatr Pulmonol. 2015; 50:1113–1118. © 2014 Wiley Periodicals, Inc.