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Respiratory outcome in preterm ventilated infants: importance of early respiratory system resistance
Yvonne Snepvangers1, J Peter de Winter, Huibert Burger
1Department of Paediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, KH 01.419.0, 85090, 3508 AB Utrecht, The Netherlands. yvonne.snepvangers@wanadoo.nl
Insights
Early high respiratory resistance in preterm infants predicts long-term breathing problems. Respiratory system properties, not just neonatal conditions, are key to respiratory outcomes in ventilated infants.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Respiratory Physiology
Background:
- The causes of long-term respiratory issues in preterm infants may be shifting due to decreasing acute respiratory distress syndrome (RDS) severity.
- Early assessment of respiratory mechanics is crucial for understanding long-term respiratory health in vulnerable infants.
Purpose of the Study:
- To determine if early neonatal respiratory resistance (Rrsneo) and compliance (Crsneo) predict respiratory morbidity and lung function abnormalities in the first year of life.
- To investigate the association between respiratory mechanics in early life and at one year with long-term respiratory outcomes in ventilated preterm infants.
Main Methods:
- Mechanically ventilated preterm infants (<37 weeks gestation) had daily Rrs and Crs measured within 24 hours of birth.
- Rrs and Crs were reassessed at one year of age.
- Statistical analysis, including logistic regression, was used to identify predictors of respiratory morbidity and lung function abnormalities.
Main Results:
- Increased early neonatal respiratory resistance (Rrsneo), after adjusting for endotracheal tube size, was significantly associated with increased respiratory morbidity during the first year of life (OR 1.20).
- Higher Rrsneo and Rrs at one year, and lower Crs at one year, were linked to poorer respiratory outcomes.
- Early neonatal respiratory compliance (Crsneo) did not show significant associations with long-term respiratory outcomes.
Conclusions:
- In the current surfactant treatment era, elevated early neonatal respiratory resistance, rather than compliance, is a significant predictor of poor respiratory outcomes in preterm infants.
- Inborn respiratory system characteristics appear more critical than neonatal disease or treatment conditions for long-term respiratory health in this population.
Unlabelled:
Since severity of acute respiratory distress syndrome (RDS) has been decreasing, the aetiology of long-term respiratory problems may have changed in preterm infants. We investigated whether early neonatal respiratory resistance (Rrs) and compliance (Crs) were important determinants of respiratory morbidity and lung function abnormalities during the 1st year of life in ventilated preterm infants. In 70 infants of less than 37 weeks gestation, mechanically ventilated within 24 h after birth, Rrs and Crs were assessed daily during the first 3 days of life and medians were calculated subsequently (Rrsneo and Crsneo). Rrs and Crs were reassessed 1 year later in 57 of 70 infants (Rrs(1 year) and Crs(1 year)). After correction for endotracheal tube size, increased Rrsneo was significantly related to respiratory morbidity during the 1st year of life (OR 1.20, 95% CI 1.04 to 1.38; P = 0.013), increased Rrs(1 year) (multiplicative beta per kPa/l x s 1.017, 95% CI 1.000 to 1.034; P = 0.045), and decreased Crs(1 year) (multiplicative beta per kPa/l x s 0.986, 95% CI 0.974 to 0.998; P = 0.023). Associations were not adversely affected by degree of prematurity, neonatal disease and treatment. Crsneo did not show any significant associations. In the current surfactant era, increased Rrsneo, and not Crsneo was associated with poor respiratory outcome during the 1st year of life in preterm ventilated infants. Relationships were not adversely affected by measures reflecting degree of prematurity, neonatal disease, and ventilator conditions.
Conclusion:
our results indicate that inborn properties of the respiratory system have become increasingly important in relation to respiratory outcome instead of neonatal disease and treatment conditions.
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