The effect of gestational age on the effective elastance of the respiratory system in neonates

We measured the effective elastance of the respiratory system (E'RS) in 38 "healthy" neonates, gestational ages ranging from 28-42 weeks. E'RS was calculated by dividing the inspiratory pressure generated after nasal occlusion by the tidal volume of the breath preceding occlusion (E'RS = P/VT). E'RS decreased from 790 +/- 0.070 cm H2O/liter at 30.4 +/- 0.4 weeks of gestation to 520 +/- 0.030 at 34.5 +/- 0.3 weeks (P less than 0.01); then to 340 +/- 0.020 at 40 +/- 0.2 weeks (P less than 0.01). E'RS corrected for lung volume ("specific" E'RS) were 32 +/- 2,32 +/- 4, and 28 +/- 2 cm H2O at the above gestational ages, respectively (P greater than 0.05). We suggest: (1) the increased E'RS observed in preterm infants is lung volume dependent. Changes in lung volume may alter the geometry of the thorax, and therefore, the force/length characteristics of the respiratory muscles; (2) this increased E'RS is not of much benefit to preterm infants who have little respiratory stability when E'RS is maximum; and (3) if E'RS is an index of mechanical stability, apnea in preterm infants is independent of the mechanical properties of the respiratory system.