Related Experiment Video
Updated: Sep 1, 2025
Author Spotlight: Unraveling the Impact of Mechanical Ventilation on Diaphragm Function and Patient Outcomes
Published on: November 3, 2023
Diaphragmatic Thickness and Excursion in Preterm Infants With Bronchopulmonary Dysplasia Compared With Term or Near
Telford Yeung1, Nada Mohsen2, Mohab Ghanem3
1Department of Pediatrics, University Health Network, University of Toronto; Department of Pediatrics, Mount Sinai Hospital, Toronto; Department of Pediatrics, Windsor Regional Hospital Metropolitan campus, Windsor, ON, Canada.
Insights
Bronchopulmonary dysplasia (BPD) in preterm infants is linked to lower diaphragm thickness but increased diaphragm movement. Further research is needed to understand these changes in infants with BPD.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Medical Imaging
Background:
- Diaphragmatic atrophy is known in ventilated adults and children.
- This association has not been previously described in preterm infants with bronchopulmonary dysplasia (BPD).
Purpose of the Study:
- To investigate whether BPD impacts diaphragm thickness (DT) and diaphragm excursion (DE) in preterm infants.
- To compare these parameters in infants with BPD versus healthy controls.
Main Methods:
- Prospective observational case-control study involving 111 infants (56 with BPD, 55 controls).
- Bedside ultrasound assessed DT at end-expiration (DTexp), DT at end-inspiration (DTins), DT fraction (DTF), and DE.
- Diaphragmatic measurements were normalized to body surface area (BSA).
Main Results:
- Infants with BPD showed significantly lower DTexp and DTexp/BSA ratio compared to controls.
- Infants with BPD exhibited significantly higher DTF and DE than healthy controls.
- P-values < .05 indicated statistical significance for all findings.
Conclusions:
- Preterm infants with BPD exhibit reduced diaphragm thickness but increased diaphragm movement compared to healthy controls.
- These findings suggest altered diaphragmatic mechanics in infants with BPD.
- Further research is warranted to track the evolution of diaphragmatic dimensions in infants with and without BPD.
Background:
Diaphragmatic atrophy associated with mechanical ventilation is reported in pediatric and adult patients, but a similar association has not been described in preterm infants with bronchopulmonary dysplasia (BPD).
Research Question:
Does BPD impact the diaphragm thickness (DT) and diaphragm excursion (DE) in infants born before 32 weeks' gestation compared with healthy late preterm or term infants?
Study Design And Methods:
In this prospective observational case-control study, DT at end of expiration (DTexp), DT at end of inspiration (DTins), DT fraction (DTF), and DE (DE) were assessed using bedside ultrasound. Two groups were compared: infants with BPD (patients) and healthy, postmenstrual age-matched infants (control participants). To account for variations in body size between groups, diaphragmatic measurements were expressed as a ratio of body surface area (BSA). Statistical analyses were conducted using SAS software version 9.4 (SAS Institute, Inc.).
Results:
We enrolled 111 infants, including 56 preterm infants with BPD (mean ± SD study age, 37.7 ± 1.7 weeks) and 55 healthy control participants (mean ± SD study age, 38.1 ± 1.5 weeks). DTexp and DTexp to BSA ratio were significantly lower in the BPD group compared with the healthy control group (mean ± SD, 1.3 ± 0.4 mm vs 1.5 ± 0.4 mm [P = .01] and 7.1 ± 1.4 mm/m2 vs 7.8 ± 1.8 mm/m2 [P = .03]). DTF and DE were significantly higher in the BPD group vs the healthy control group (mean ± SD, 61.8 ± 26.0 vs 43.3 ± 19.7 [P < .01] and 6.0 ± 1.7 mm vs 4.4 ± 1.6 mm [P < .01], respectively).
Interpretation:
In infants with BPD, DTexp was significantly lower, whereas DTF and DE were significantly higher, compared with healthy, age-matched control participants. Future studies are required and should focus on describing the evolution of diaphragmatic dimensions in preterm infants with and without BPD.
Trial Registry:
ClinicalTrials.gov; No.: NCT04941963; URL: www.
Clinicaltrials:
gov.
Related Concept Videos
01:30Respiratory System Abnormal Finding I: Inspection and Percussion
Inspection Findings
During an inspection, several findings may suggest the presence of respiratory distress or disease. Pursed-lip breathing, where exhalation is slowed by...
01:17Pulmonary Cycle: Exhalation
01:24Physical Assessment of the Respiratory Tract II: Palpation
Thoracic Palpation
Thoracic palpation detects tenderness, masses, lesions, respiratory excursions, and vocal fremitus. The nurse assesses...
01:27Physical Assessment of the Respiratory Tract II: Inspection
Chest Configuration
The chest configuration...
01:29Assessment of Ventilation II: Respiratory Depth and Rhythm
Respiratory depth measures the volume of air inhaled or exhaled during a breath. It can vary from shallow to deep and typically remains consistent when a person is at rest or asleep. Occasionally, individuals will automatically inhale deeply, known as sighing, which inflates the lungs with more air than normal breathing.
To assess respiratory depth, observe the degree of chest excursion or movement:
01:29Physical Assessment of the Respiratory Tract III: Percussion
Percussion in Respiratory Assessment
Percussion evaluates underlying tissue composition with audible and tactile vibrations,...