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Pulmonary function until two years of life in infants with bronchopulmonary dysplasia
E Baraldi1, M Filippone, D Trevisanuto
1Department of Pediatrics, University of Padova School of Medicine, Italy.
Insights
Infants with bronchopulmonary dysplasia (BPD) show improving lung mechanics over two years. However, airway function remains impaired, indicated by reduced forced expiratory flows in most children.
Area of Science:
- Pediatric Pulmonology
- Neonatal Medicine
- Respiratory Physiology
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting premature infants.
- Pulmonary sequelae in BPD survivors require long-term evaluation.
Purpose of the Study:
- To assess the longitudinal changes in pulmonary function in infants with BPD.
- To characterize the recovery of lung mechanics and airflow in BPD survivors up to two years of age.
Main Methods:
- Serial pulmonary function tests were conducted on 24 infants with BPD from birth to 2 years.
- Measurements included respiratory system compliance (Crs), resistance (Rrs), functional residual capacity (FRC), and forced expiratory flow (Vmax,FRC).
Main Results:
- Severe impairment in Crs and abnormal Rrs were observed in the acute phase.
- Significant improvements in Crs and Rrs were noted within the first year, reaching normal ranges by 24 months.
- FRC normalized and increased above predicted values by 2 years.
- Despite improved mechanics, 70% of children exhibited >40% reduction in Vmax,FRC at 2 years.
Conclusions:
- Pulmonary mechanics in BPD survivors significantly improve during early childhood.
- Persistent airway obstruction, evidenced by reduced forced expiratory flows, remains a significant issue in BPD survivors at two years of age.
Abstract:
To evaluate the physiologic course of pulmonary function in infants with bronchopulmonary dysplasia (BPD) weighing less than 1,250 g at birth, 24 infants with BPD underwent serial pulmonary function evaluations from birth until 2 yr of age. All infants were intubated at birth and the mean duration of mechanical ventilation was 38 +/- 4 d. Passive respiratory system compliance (Crs) and resistance (Rrs) were measured between 10 and 20 d of life during mechanical ventilation. Thereafter pulmonary mechanics and functional residual capacity (FRC) were evaluated at 3, 6, 9, 12, and 24 mo of postnatal age. Forced expiratory flow (Vmax,FRC) was measured at 2 yr of age. A severe alteration on Crs (50% of predicted) was found during the acute phase of BPD, associated with abnormal values of Rrs. A progressive improvement (ANOVA, p < 0.0001) occurred in the first year of life and, at 24 mo of age, Crs and Rrs reached the range of normalcy. FRC value was 86 +/- 7.5% of predicted at 3 mo and gradually increased to a mean value of 115 +/- 5% of predicted at 2 yr of age. In spite of the good resistance time course over the 2-yr evaluation, less favorable data of Vmax,FRC were found with individual values reduced more than 40% of predicted values in 70% of the children. In conclusion, although pulmonary mechanics of BPD survivors improves during the first years of life, reaching the range of normal values, at 2 yr of age they still present a substantial airway function impairment as revealed by the low forced expiratory flows.