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Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
Respiratory function and symptoms in young preterm children in the contemporary era
Maureen Verheggen1,2,3, Andrew C Wilson1,2,3,4, J Jane Pillow5,6,7
1Department of Respiratory Medicine, Princess Margaret Hospital for Children, GPO Box D184, Perth 6840, Australia.
Insights
Preterm children exhibit impaired lung function compared to healthy peers. Respiratory reactance, specifically, distinguishes between those with and without bronchopulmonary dysplasia, and is affected by oxygen therapy duration.
Area of Science:
- Pediatric Pulmonology
- Neonatal Medicine
- Respiratory Physiology
Background:
- Preterm birth (<32 weeks gestation) is associated with increased risk of respiratory complications.
- Bronchopulmonary dysplasia (BPD) is a common chronic lung disease in preterm infants.
- Long-term respiratory outcomes in young children born preterm require further investigation.
Purpose of the Study:
- To investigate the relationship between respiratory symptoms, lung function, and neonatal events in young preterm children.
- To compare lung function between preterm children with and without BPD and healthy term controls.
- To identify factors influencing lung function in this population.
Main Methods:
- A cohort of preterm children (<32 weeks gestation) and healthy term controls aged 4-8 years were studied.
- Lung function was assessed using spirometry and the forced oscillation technique (measuring respiratory resistance [Rrs] and reactance [Xrs]).
- Respiratory symptom questionnaires were administered to participants and/or their caregivers.
Main Results:
- Preterm children demonstrated significantly impaired lung function (FVC, FEV1, Xrs, Rrs) compared to controls.
- Respiratory reactance (Xrs) was significantly lower in preterm children with BPD compared to those without BPD.
- The prevalence of recent respiratory symptoms did not differ between BPD and non-BPD groups; however, supplemental oxygen in the hospital was associated with worse Xrs and FEV1.
Conclusions:
- Young preterm children exhibit persistent deficits in lung function compared to healthy term-born children.
- Respiratory reactance is a key indicator differentiating preterm children with and without BPD.
- Neonatal factors, such as duration of supplemental oxygen, can negatively impact long-term lung function in preterm survivors.
Objective:
To determine the relationships between respiratory symptoms, lung function, and neonatal events in young preterm children.
Methods:
Preterm children (<32 w gestation), classified as bronchopulmonary dysplasia (BPD) or non-BPD, and healthy term controls were studied. Lung function was measured by forced oscillation technique (respiratory resistance [Rrs] and reactance [Xrs]) and spirometry. Respiratory symptom questionnaires were administered.
Results:
One hundred and fifty children (74 BPD, 44 non-BPD, 32 controls) 4-8 years were studied. Lung function (median Z-score [10,90th centile]) was significantly impaired in preterm children compared to controls for FVC (0.00 [-1.18, 1.76], 0.69 [-0.17,1.86]), FEV1 (-0.44 [-1.94, 1.11], 0.49 [-0.83, 2.51]), Xrs (-1.26 [-3.31, 0.11], -0.11 [-0.97, 0.73]), and Rrs (0.55 [-0.48, 1.82], 0.28 [-0.99, 0.96]). Only Xrs differed between the BPD and non-BPD (-1.51 [-3.59, -0.41], -0.89 [-2.64, 0.52]). The prevalence of recent respiratory symptoms (range: 32-36%) did not differ between BPD and non-BPD children. Supplemental O2 in hospital was positively associated with worsening Xrs and FEV1 .
Conclusion:
Preterm children have worse lung function than healthy controls. Only respiratory reactance differentiated between preterm children with and without BPD and was influenced by days of O2 in hospital. Pediatr Pulmonol. 2016;51:1347-1355. © 2016 Wiley Periodicals, Inc.
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