Determinants of forced expiratory flows in newborn infants

Maximal flows at functional residual capacity (VmaxFRC) from partial expiratory flow-volume (PEFV) curves (achieved with rapid compression of the chest) were obtained on 11 healthy newborn babies. Mean VmaxFRC, size corrected by dividing absolute values by measured thoracic gas volume, was 1.90 TGV's/s. Specific upstream conductances were high, and the cross-sectional area of the flow-limiting segment was estimated to be approximately 0.30 cm2 in the three infants on whom recoil pressures at FRC were also measured. The cross-sectional area of the major bronchi in the neonate is approximately 0.26-0.30 cm2. PEFV curves were convex to the volume axis. Many of the neonates increased their flows while breathing a helium-oxygen gas mixture. These results suggest 1) size-corrected flows are higher in the neonate than in older children or adults; 2) the site of the flow-limiting segment at FRC during maximal expiratory maneuvers is in large proximal airways, similar to the adult; and 3) the relationship of airway size to parenchymal size may be similar in neonates and adults or, in fact, airways may be larger, relative to parenchyma, in neonates. These physiological data do not support the hypothesis, based on pathological studies, that peripheral airways are disproportionately smaller (when compared with central airways) in infants than in adults.