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[Evolution of the result of respiratory function studies in children with bronchopulmonary dysplasia]
Insights
Infants with bronchopulmonary dysplasia (BPD) show persistent lung function abnormalities, including reduced compliance and increased resistance, requiring extended monitoring. Improvements in pulmonary compliance and oxygenation were observed between tests.
Area of Science:
- Pediatric Pulmonology
- Neonatology
- Respiratory Physiology
Context:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting premature infants.
- Limited data exists on the short- and medium-term evolution of lung function in infants with BPD.
- Understanding lung function changes is crucial for managing BPD outcomes.
Purpose:
- To evaluate the short- and medium-term changes in lung function tests (LFT) in infants with BPD.
- To compare LFT results in infants with BPD to healthy controls.
- To identify factors associated with respiratory abnormalities in BPD.
Summary:
- Infants with BPD exhibited significant abnormalities in thoracic gas volume, pulmonary compliance, and total pulmonary resistance in both early and later LFTs.
- Hypoxemia and hypercapnia persisted throughout the study period in infants with BPD.
- While thoracic distention and resistance did not improve, pulmonary compliance and PaO2 showed improvement between the first and second LFTs.
Impact:
- This study highlights the prolonged respiratory functional deficits in infants with BPD.
- Findings suggest the need for extended follow-up and tailored respiratory support for these infants.
- Identifying correlations between respiratory parameters and ventilation strategies can inform clinical practice.
Background:
Reports of short- and medium-term evolution of Lung Function Tests (LFT) in infants with bronchopulmonary dysplasia (BPD) are still scarce.
Population And Methods:
The results of the first (before 3 months of corrected age) and the second (between 3 and 9 months of corrected age) LFT in 22 premature infants with BPD (gestational age 31 +/- 2.5 weeks; birth weight: 1570 +/- 440 g; duration of mechanical ventilation: 46 +/- 24 days, total duration of oxygen therapy: 88 +/- 47 days) were compared to those obtained in 27 normal infants for the first LEF and 10 normal infants for the second LFT, similar to the patients for birth weight and corporeal index (CI).
Results:
In the first LFT, major abnormalities were an increased thoracic gaz volume (TGV) (16.5 +/- 42 vs 122 +/- 24 mL; P < 0.001) and TGV CI ratio (1.25 +/- 0.31 vs 0.89 +/- 0.17 ml/kg/m2; P < 0.0001) a decreased pulmonary compliance (2.49 +/- 1.46 vs 11.60 +/- 4.50 mL/cmH2O; P < 0.0001) and specific pulmonary compliance (0.015 +/- 0.10 vs 0.100 +/- 0.042 mL/cmH2O/mL de TGV; P < 0.0001), an increased total pulmonary resistance (20.4 +/- 12.1 vs 10.5 +/- 5.3 cmH2O/L/s; P < 0.001). In the second LFT, an increased TGV (235 +/- 62 vs 166 +/- 28 mL; P < 0.01) and TGV CI ratio (1.64 +/- 0.65 vs 0.98 +/- 0.11 ml/kg/m2; P < 0.05), a decreased pulmonary compliance (2.68 +/- 2.0 vs 15.2 +/- 5.7 mL/cmH2O; P < 0.0001) and specific pulmonary compliance (0.013 +/- 0.010 vs 0.106 +/- 0.050 mL/cmH2O/mL de TGV; P < 0.0001), an increased total pulmonary resistance (17.1 +/- 9.6 vs 8.6 +/- 4.9 cmH2O/L/s; P < 0.05) were noted when compared with the control group results. Major abnormalities of the blood gases were hypoxemia (63 +/- 10 vs 85 +/- 20 mmHg; P < 0.05), hypercapnia (38.5 vs 31 +/- 4 mmHg; P < 0.0001) during the first LFT. Hypoxemia (77 +/- 14 vs 90 +/- 14 mmHg and hypercapnia (37 +/- 4 vs 29 +/- 5 mmHg) continued in the second LFT. Thoracic distention and total pulmonary resistances in infants with BPD did not improve but their pulmonary compliance (P < 0.0001) and PaO2 (P < 0.01) between the first and second LFT did it. Infants who had been ventilated for a hyaline membrane disease (HMD) were more hypoxic on the second LFT (P < 0.05) than those who had been ventilated for other causes. Statistically significant relationships were found between thoracic distention and duration of positive inspiratory pressure (P < 0.05; r = 0.43), duration of positive expiratory pressure (P < 0.05, r = 0.45) total oxygen therapy duration; between total pulmonary resistance and duration of mechanical ventilation with high frequency (P < 0.05; r = 0.52); between hypoxemia and duration of oxygen therapy with FiO2 > or = 60% (P < 0.05; r = 0.54).
Conclusions:
This study shows prolonged clinical and functional abnormalities of the respiratory functions requiring longer follow-up.