Related Experiment Video
Updated: Feb 25, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Ventilatory Efficiency in Children and Adolescents Born Extremely Preterm
Julie Hestnes1, Hedda Hoel1, Ole J Risa1
1Department of Clinical Science, University of BergenBergen, Norway.
Insights
Children born extremely preterm (EP) have poorer ventilatory efficiency during exercise, breathing more to produce carbon dioxide. Their breathing patterns were similar to term-born individuals when lung function was considered.
Area of Science:
- Pediatric Pulmonology
- Exercise Physiology
- Neonatology
Background:
- Extremely preterm (EP) born individuals often exhibit reduced lung function.
- Lower aerobic capacity is frequently observed in EP-born populations compared to term-born peers.
Purpose of the Study:
- To investigate if ventilatory efficiency and breathing patterns during exercise differ between EP-born and term-born individuals.
- To test the hypothesis of poorer ventilatory efficiency and altered breathing patterns in EP-born subjects.
Main Methods:
- Comparison of two EP cohorts (born 1982-85 and 1991-92) with individually matched term-born controls during incremental treadmill exercise.
- Analysis of ventilatory efficiency using the relationship between exhaled minute ventilation (VE) and carbon dioxide output (VCO2).
- Assessment of breathing patterns, including tidal volume (VT) and VE, with multivariate regression adjusting for covariates like FEV1.
Main Results:
- EP-born individuals demonstrated a significantly steeper VE-VCO2 relationship, indicating lower ventilatory efficiency.
- No significant group differences in breathing patterns were found when adjusted for forced expiratory volume in 1 second (FEV1).
- Breathing patterns were primarily associated with FEV1, not the birth group (EP vs. term).
Conclusions:
- Extremely preterm birth is associated with reduced ventilatory efficiency during exercise.
- Higher ventilation relative to carbon dioxide output in EP-born individuals may contribute to their lower aerobic capacity.
- Observed breathing patterns in EP-born individuals are comparable to term-born peers once lung function (FEV1) is accounted for.
Abstract:
Purpose: Children and adolescents born extremely preterm (EP) have lower dynamic lung volumes and gas transfer capacity than subjects born at term. Most studies also report lower aerobic capacity. We hypothesized that ventilatory efficiency was poorer and that breathing patterns differed in EP-born compared to term-born individuals. Methods: Two area-based cohorts of participants born with gestational age ≤28 weeks or birth weight ≤1000 g in 1982-85 (n = 46) and 1991-92 (n = 35) were compared with individually matched controls born at term. Mean ages were 18 and 10 years, respectively. The participants performed an incremental treadmill exercise test to peak oxygen uptake with data averaged over 20 s intervals. For each participant, the relationship between exhaled minute ventilation ([Formula: see text]E) and carbon dioxide output ([Formula: see text]CO2) was described by a linear model, and the relationship between tidal volume (VT) and [Formula: see text]E by a quadratic model. Multivariate regression analyses were done with curve parameters as dependent variables, and the categories EP vs. term-born, sex, age, height, weight and forced expiratory volume in 1 s (FEV1) as independent variables. Results: In adjusted analyses, the slope of the [Formula: see text]E-[Formula: see text]CO2 relationship was significantly steeper in the EP than the term-born group, whereas no group difference was observed for the breathing pattern, which was related to FEV1 only. Conclusion: EP-born participants breathed with higher [Formula: see text]E for any given CO2 output, indicating lower ventilatory efficiency, possibly contributing to lower aerobic capacity. The breathing patterns did not differ between the EP and term-born groups when adjusted for FEV1.
Related Concept Videos
01:19Factors Affecting Pulmonary Ventilation
Alveolar Surface Tension
The alveolar fluid lines the luminal surface of the alveoli and exerts a force called surface tension. This force is caused by the polar water molecules in the liquid being more strongly attracted to each...
01:22Respiratory Volumes and Capacities
01:24Respiratory Capacities
One key metric is the Inspiratory Capacity (IC), which represents the maximum amount of air that can be inhaled with full effort. IC is calculated by summing the tidal volume and inspiratory reserve volume, typically ranging from 2.4 to 3.6 liters.
The Functional Residual Capacity (FRC) represents the air in the...
01:26Respiratory Volumes and Capacities I
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
01:23Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...