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Lung function measurement in prematurely born preschool children with and without chronic lung disease
V R Kairamkonda1, J Richardson, N Subhedar
1Department of Neonatal Intensive Care, Leicester Royal Infirmary, Leicester, UK. venkatesh.kairamkonda@uhl-tr.nhs.uk
Insights
Interrupter resistance (Rint) testing is feasible in preschool children born prematurely. This method can identify airway obstruction in those with chronic lung disease (CLD), serving as a valuable screening tool.
Area of Science:
- Pediatric Pulmonology
- Neonatology
- Respiratory Physiology
Background:
- Premature infants frequently experience recurrent wheeze and long-term respiratory issues.
- Assessing airway obstruction in young children is challenging, with limited data in preterm populations, especially those with chronic lung disease (CLD).
Purpose of the Study:
- To evaluate the feasibility of lung function measurement using the interrupter technique (Rint) in prematurely born preschool children.
- To assess respiratory health and identify potential airway obstruction in preterm children with and without CLD.
Main Methods:
- Enrolled preterm children aged 2-4 years with (n=43) and without (n=33) severe CLD.
- Utilized a portable device (MicroRint) for interrupter resistance (Rint) measurements, aiming for at least five valid readings.
- Assessed feasibility based on Rint test outcomes (satisfactory, failure, rejected) and recorded respiratory symptom scores.
Main Results:
- Satisfactory Rint measurements were obtained in 61% of children, with feasibility increasing with age.
- Preterm children with severe CLD exhibited significantly higher respiratory symptom scores and Rint values compared to controls.
- Rint measurements were significantly higher in children with CLD (z-scores 1.42 vs 1.0).
Conclusions:
- Interrupter resistance (Rint) measurement is a feasible method for assessing lung function in preschool-aged children born prematurely in an ambulatory setting.
- Increased Rint in preschool children with severe CLD can help differentiate them from preterm children without CLD.
- Rint may serve as a useful screening tool and outcome measure for interventions in this population.
Objective:
Prematurely born infants often have recurrent wheeze and long-term respiratory morbidity at follow-up. Assessment of airways obstruction in preschool children is feasible using the interrupter resistance (Rint) but has rarely been examined in preterm children with and without chronic lung disease (CLD). The objective of this study was to determine lung function measured by the interrupter technique, its feasibility in the ambulatory setting and respiratory health in prematurely born preschool children with and without CLD.
Study Design:
Preterm children of 2 to 4 years with severe CLD (>30% oxygen at 36 weeks and discharged home receiving supplemental oxygen) (n=43, median gestational age 27 weeks and median birth weight 995 g) and without CLD (n=33, median gestational age 29 weeks and median birth weight 1366 g) attempting lung function test for the first time were enrolled. Respiratory symptoms score was calculated using a questionnaire. A single set of 10 consecutive Rint measurements was obtained using a portable device (MicroRint). Median of at least five occlusions with consistent shape of mouth pressure-time curves was taken to be a Rint measurement. To assess feasibility the children were categorized as 'satisfactory', 'failure' and 'rejected' depending on the outcome of the test. Outcome variables were respiratory symptoms score and Rint.
Result:
Satisfactory Rint measurement was obtained in 46 (61%) children, 9 (36%) 2-year olds, 17 (65%) 3-year olds and 20 (80%) 4-year olds. As compared with the preterm control children (n=18), CLD children (n=28) had significantly higher respiratory symptoms score (18.5 vs 6, P<0.01) and Rint expressed as absolute values (kPa l(-1)) and z-scores (1.33 vs 1.16 and 1.42 vs 1.0, P<0.01), respectively.
Conclusion:
Rint measurement is feasible in prematurely born children of preschool age in the ambulatory setup. Preschool children with severe CLD may be identified from preterm children without CLD by increased Rint that may be used as a screening tool and as an outcome measure for interventions.
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