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Lung function in African infants: a pilot study
D M Gray1, L Willemse, A Alberts
1Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Insights
Infant lung function testing is feasible in South Africa, providing crucial data for respiratory health in low-income countries. This pilot study shows successful implementation of tidal breathing, exhaled nitric oxide, and multiple breath washout measures.
Area of Science:
- Pediatric Pulmonology
- Global Health
- Respiratory Medicine
Background:
- Childhood respiratory illnesses pose a significant burden in low and middle-income countries (LMICs).
- Infant lung function (ILF) testing can reveal insights into lung development and disease susceptibility.
- ILF testing has been largely inaccessible in LMICs, despite the high prevalence of respiratory diseases.
Purpose of the Study:
- To pilot the implementation and assess the feasibility of infant lung function testing in a semi-rural South African setting.
- To evaluate the effectiveness of established ILF testing protocols in a resource-limited environment.
Main Methods:
- Established ILF testing at a community hospital, utilizing unsedated infants during sleep.
- Employed measures including tidal breathing (TBFVL), exhaled nitric oxide (eNO), and sulfur hexafluoride multiple breath washout (MBW).
- Utilized an ultrasonic flow meter and chemoluminescent NO analyzer for precise measurements.
Main Results:
- Successfully tested 20 infants (mean age 7.7 weeks), including preterm and diverse ethnic groups.
- Achieved high success rates: 95% for TBFVL and eNO, 90% for MBW.
- Obtained lung function values comparable to normative data from high-income countries, with low intra-subject variability.
Conclusions:
- Demonstrated the feasibility of conducting unsedated infant lung function tests (tidal breathing, MBW, eNO) in a semi-rural African setting.
- ILF testing in this LMIC context yielded results comparable to those from high-income countries.
- This pilot study supports the expansion of ILF testing to improve respiratory health management in underserved populations.
Background:
The burden of childhood respiratory illness is large in low and middle income countries (LMICs). Infant lung function (ILF) testing may provide useful information about lung growth and susceptibility to respiratory disease. However, ILF has not been widely available in LMICs settings where the greatest burden of childhood respiratory disease occurs.
Aim:
To implement and evaluate a pilot study of ILF testing in a semi-rural setting in South Africa.
Method:
Infant lung function testing was established at a community hospital in South Africa. All measures were done in unsedated infants during sleep. Measurements, made with the infant quietly breathing through a face mask and bacterial filter, included tidal breathing (TBFVL), exhaled nitric oxide (eNO), and sulphur hexafluoride multiple breath washout (MBW) measures using an ultrasonic flow meter and chemoluminescent NO analyzer.
Results:
Twenty infants, mean age of 7.7 (SD 2.9) weeks were tested; 8 (40%) were Black African and 12 (60%) were mixed race. Five (25%) infants were preterm. There were 19 (95%) successful TBFVL and NO tests and 18 (90%) successful MBW tests. The mean tidal volume was 30.5 ml (SD 5.9), respiratory rate 50.2 breaths per minute (SD 8.7), and eNO 10.4 ppb (SD 7.3). The mean MBW measures were: functional residual capacity 71 ml (SD 13) and the lung clearance index 7.6 (SD 0.5). The intra-subject coefficient of variations (CV) of lung function measures were similar to published normative data for Caucasian European infants.
Conclusion:
In this study we demonstrate that unsedated infant lung function measures of tidal breathing, MBW, and eNO are feasible in a semi-rural African setting with rates comparable to those reported from high income countries.
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