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Exhaled nitric oxide in infants--what is a nice test like FENO doing in a place like this?

Esther van Mastrigt1, Carmelo Gabriele, J C de Jongste

  • 1Department of Pediatrics-Respiratory Medicine, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.

Seminars in Respiratory and Critical Care Medicine
|June 15, 2007
PubMed

Insights

Fractional exhaled nitric oxide (FENO) measurement shows promise for diagnosing infant conditions like early-onset asthma and primary ciliary dyskinesia. However, standardized methods and reference values are needed for reliable infant FENO testing.

Area of Science:

  • Pediatric Pulmonology
  • Allergy and Immunology
  • Biomedical Engineering

Background:

  • Fractional exhaled nitric oxide (FENO) is a validated biomarker for eosinophilic airway inflammation in older children and adults.
  • Current FENO measurement techniques are not optimized for infants and preschool-aged children.
  • Wheezing in infants is often transient and linked to viral infections, differing from asthma in older populations.

Purpose of the Study:

  • To review existing data on FENO measurements in infants.
  • To explore the potential clinical utility of FENO in diagnosing and monitoring infant respiratory conditions.
  • To identify challenges and future research needs for infant FENO assessment.

Main Methods:

  • Review of available literature on FENO measurements in infants.
  • Discussion of technical factors influencing FENO levels in infants, including nasal contamination and expiratory flow.
  • Analysis of potential applications of FENO in infant diagnostics.

Main Results:

  • FENO can be measured in infants using tidal breathing or forced passive expiration techniques.
  • Technical challenges such as nasal NO contamination and expiratory flow significantly impact infant FENO readings.
  • Preliminary data suggest FENO may aid in identifying early-onset asthma and primary ciliary dyskinesia (PCD) in infants.

Conclusions:

  • Significant uncertainty remains regarding the clinical utility of FENO in infants.
  • Further research is required to establish standardized methodologies and normal reference values for infant FENO measurements.
  • Clinical studies are needed to demonstrate the specific benefits and limitations of FENO testing in this age group.

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