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Tidal Breathing Analysis as a Prognostic Index for Airway Obstruction Trajectory and Asthma in Preterm Infants
Yoon Hee Kim1,2, Mireu Park2,3, Soo Yeon Kim2,3
1Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Insights
Time to peak expiratory flow/expiratory time (TPEF/TE) in infancy predicts later airway obstruction and asthma in preterm infants. Lower TPEF/TE indicates a persistent lower pulmonary function trajectory until age 13.
Area of Science:
- Pediatric Pulmonology
- Neonatal Respiratory Medicine
- Asthma Research
Background:
- Preterm infants face lifelong respiratory morbidities.
- Accurate lung function assessment in infancy is vital for managing these conditions.
- Predicting long-term respiratory outcomes is crucial for early intervention.
Purpose of the Study:
- To identify pulmonary function parameters in infancy that predict airway obstruction and asthma development after age 4 in preterm infants.
- To analyze the association between infant pulmonary function and long-term respiratory trajectories up to age 13.
- To assess the predictive value of infant lung function for persistent respiratory issues.
Main Methods:
- Evaluated 52 preterm infants using tidal breathing flow-volume loop (TBFVL) and multiple-breath washout (MBW) in infancy.
- Conducted spirometry at age 4 years and assessed pulmonary function trajectories until age 13.
- Analyzed associations between infant pulmonary function parameters and childhood/adolescent lung function and asthma development.
Main Results:
- Infant Time to Peak Expiratory Flow/Expiratory Time (TPEF/TE) correlated with childhood FEV1, FEF25-75, and dysanapsis ratio.
- Lower TPEF/TE in infancy significantly predicted airway obstruction and asthma post-age 4, even after adjusting for risk factors.
- Preterm infants with lower TPEF/TE exhibited persistently low pulmonary function until age 13.
Conclusions:
- Infant TPEF/TE is a valuable predictor of post-4-year-old airway obstruction and asthma in preterm infants.
- TPEF/TE can identify preterm infants with a trajectory of lower pulmonary function extending to age 13.
- These findings support lifelong management strategies for preterm-born children with pulmonary morbidities.
Introduction:
An easy-to-implement and accurate lung function assessment tool for preterm infants is crucial to manage lifelong respiratory morbidities. We aimed to determine which pulmonary function parameters in preterm infants can predict the trajectory of airway obstruction and asthma development after 4 years of age.
Methods:
We evaluated 52 preterm infants who had undergone both tidal breathing flow-volume loop (TBFVL) and multiple-breath washout (MBW) analyses in infancy and spirometry after the age of 4 years. We evaluated the association between pulmonary function parameters in infancy and childhood and the pulmonary function trajectory until 13 years of age and compared the changes in this trajectory according to pulmonary function parameters in infancy.
Results:
Time to peak expiratory flow/expiratory time (TPEF/TE) in infancy was associated with FEV1, FEF25-75, and dysanapsis ratio in childhood and differed according to level of airway obstruction assessed by FEV1, FEV1/FVC, and FEF25-75, an asthma development. TPEF/TE was a significant predictive factor for airway obstruction and asthma after 4 years of age, after adjusting for sex, extreme prematurity, duration of supplementary oxygen and mechanical ventilation, and recurrent wheezing during infancy. In premature infants with lower TPEF/TE, subsequent pulmonary function parameters remained low until 13 years of age.
Conclusion:
In preterm infants, TPEF/TE could be useful to predict airway obstruction and asthma after 4 years of age and even a lower pulmonary function trajectory until 13 years of age. This information may help clinicians to provide lifelong care for pulmonary morbidity in children and adolescents born preterm.
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