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Updated: Jun 19, 2025
Conducting Respiratory Oscillometry in an Outpatient Setting
Published on: April 8, 2022
Early respiratory system reactance predicts respiratory outcomes in preterm infants: a retrospective, multicentre
Emanuela Zannin1,2, Camilla Rigotti1,2, Sven M Schulzke3
1Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
Insights
Respiratory system reactance (Xrs) measured on day 7 in preterm infants predicts respiratory support duration and bronchopulmonary dysplasia (BPD). This Xrs z-score enhances prediction beyond existing clinical models.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Respiratory Physiology
Background:
- Preterm infants (<32 weeks gestational age) face significant respiratory challenges.
- Early identification of respiratory risks is crucial for timely intervention.
- Respiratory system reactance (Xrs) is a potential biomarker for airway function.
Purpose of the Study:
- To investigate the association between respiratory system reactance (Xrs) on day 7 of life and respiratory outcomes in preterm infants.
- To determine if Xrs improves prediction of respiratory support duration and bronchopulmonary dysplasia (BPD).
Main Methods:
- Retrospective study of 137 preterm infants (<32 weeks GA).
- Respiratory system reactance (Xrs) assessed via respiratory oscillometry on day 7.
- Association with respiratory support duration (linear regression) and BPD (logistic regression) analyzed.
- Xrs z-score's added predictive value to clinical factors (GA, BW, NICHD model) evaluated.
Main Results:
- Xrs z-score was significantly associated with respiratory support duration (R²=0.35).
- Higher Xrs z-scores were linked to BPD development (p<0.001), with optimal cut-off at 2.6 (77% sensitivity, 80% specificity).
- Xrs z-score significantly improved prediction of respiratory support duration and BPD development when added to clinical predictors.
Conclusions:
- Respiratory system reactance (Xrs) z-score on day 7 is a valuable predictor of respiratory outcomes in preterm infants.
- Xrs measurement offers an objective method to enhance risk stratification for respiratory complications like BPD.
Background:
This multicentre, international, retrospective study aimed to investigate whether respiratory system reactance (X rs) assessed by respiratory oscillometry on day 7 of life is associated with respiratory outcomes in preterm infants below 32 weeks gestational age (GA).
Methods:
Sinusoidal pressure oscillations (2-5 cmH2O peak-to-peak, 10 Hz) were superimposed on the positive end-expiratory pressure. We assessed the association of X rs z-score with the duration of respiratory support using linear regression and with bronchopulmonary dysplasia (BPD) using logistic regression. We used the likelihood ratio test to evaluate whether X rs z-score adds significantly to clinical predictors, including GA, birthweight (BW) and the National Institute of Child Health and Human Development (NICHD) BPD prediction model.
Results:
137 infants (median (interquartile range) 28.43 (26.11-30.29) weeks GA) were included; 44 (32%) developed BPD. X rs z-score was significantly associated with the duration of respiratory support (R2=0.35). X rs z-score was significantly higher in infants who developed BPD (p<0.001); the optimal cut-off value was 2.6, associated with 77% sensitivity and 80% specificity. In univariable analysis, per z-score increase in X rs, the odds ratio for BPD increased by 60% and the respiratory support by 8 days. In multivariable analysis, X rs z-score added significantly to the NICHD model and to GA and BW z-score to predict respiratory support duration (p=0.016 and p=0.014, respectively) and BPD development (p=0.003 and p<0.001, respectively).
Conclusion:
X rs z-score on the 7th day after birth improves the prediction of respiratory outcome in preterm infants.
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