Maximal airway pressures during crying in healthy preterm and term neonates

Respiratory muscle strength can be assessed by measurement of maximal inspiratory (PIMAX) and maximal expiratory pressure (P(EMAX)) during crying. There are, however, relatively few data on P(IMAX) and P(EMAX) in infancy, particularly from those born preterm. Our aim was to investigate which factors influenced P(IMAX) and P(EMAX) in preterm and term infants. Forty infants, median gestational age 37 weeks (range 26-43) and birthweight 2.579 kg (range 0.956-5.180) were studied at a postconceptional age (PCA) of 38 weeks (range 32-44). None had respiratory problems. A facemask was placed firmly over the infant's mouth and nose and the infant studied during spontaneous crying. A pneumotachograph fitted snugly into the facemask and from a sideport airway pressure changes were measured. During crying, the distal end of the pneumotachograph was occluded for five breaths and at least three separate occlusions were made. The highest P(EMAX) value sustained for at least 1 s and the highest peak inspiratory pressure P(IMAX) were recorded. The mean P(IMAX) and P(EMAX) were higher in the term compared to the preterm infants (70 cmH2O +/-S.D. 19 versus 58 cmH2O +/-S.D. 17 P(IMAX) and 53 cmH2O +/-S.D. 13 versus 44 cmH2O +/-S.D. 19 P(EMAX), P< 0.05). Both P(IMAX) and P(EMAX) related significantly with postconceptional age, gestational age and weight, but not postnatal age. Stepwise regression analysis demonstrated P(IMAX) related independently with PCA and P(EMAX) with weight. These results suggest respiratory muscle strength is influenced by maturation at birth.