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Pulmonary function in infants with neonatal chronic lung disease with or without hyaline membrane disease at birth
I T Merth1, J P de Winter, H M Zonderland
1Dept of Paediatrics, Leiden University, The Netherlands.
Insights
Birth weight significantly influences neonatal chronic lung disease (NCLD) development. Abnormal pulmonary function in NCLD infants at 12 months is not linked to prior hyaline membrane disease (HMD).
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Respiratory Physiology
Background:
- Neonatal chronic lung disease (NCLD) and hyaline membrane disease (HMD) are significant concerns in premature infants.
- Understanding the long-term pulmonary function effects and contributing factors is crucial for improving outcomes.
Purpose of the Study:
- To investigate the impact of NCLD, HMD, and ventilatory support on pulmonary function in the first year of life.
- To analyze the relationship between birth weight and oxygen consumption (V'O2) in these infants.
Main Methods:
- Studied 65 premature infants, categorizing them by NCLD and HMD history.
- Measured static respiratory system compliance (Crs), functional residual capacity (FRCHe), and ventilation distribution (MI) at 6 and 12 months corrected age.
- Quantified ventilatory support using peak inspiratory pressure (PIP), mean airway pressure (MAP), and fractional inspiratory oxygen (FI,O2).
Main Results:
- Infants with NCLD had lower birth weight and gestational age.
- NCLD infants exhibited reduced Crs and MI compared to controls, irrespective of HMD history.
- Pulmonary function at 12 months was not associated with prior HMD; birth weight was a key determinant of NCLD.
Conclusions:
- Birth weight is a primary factor in the development of NCLD.
- Abnormal pulmonary function in NCLD infants at 6 and 12 months corrected age is not directly linked to prior HMD.
- Findings highlight the importance of birth weight in NCLD pathogenesis and long-term respiratory outcomes.
Abstract:
We studied whether neonatal chronic lung disease (NCLD), hyaline membrane disease (HMD) and differences in ventilatory support affected pulmonary function during the first year of life, in 65 infants born prematurely. The relationship between body weight and oxygen consumption (V'O2) was also analysed. The study comprised 14 infants without cardiorespiratory disease, 19 infants with HMD but without NCLD, 9 infants with NCLD without prior HMD, and 23 infants with NCLD following HMD. At 6 and 12 months corrected postnatal age, static respiratory system compliance (Crs) was measured by weighted spirometry and the functional residual capacity by closed circuit helium dilution (FRCHe) combined with assessment of ventilation distribution from the mixing index (MI). Ventilatory support during the first 5 days of therapy was quantified from peak inspiratory pressure (PIP), mean airway pressure (MAP) and fractional inspiratory concentration of oxygen (FI,O2). Infants with NCLD had a shorter duration of gestation and lower birth weight than those without NCLD (Wilcoxon, p=0.002 and p=0.001, respectively). Pulmonary function at 6 and 12 months corrected age was not different between NCLD infants with or without HMD at birth. Infants with NCLD had lower Crs and MI than those without NCLD (analysis of variance (ANOVA), p<0.011), but their FRCHe was not different. V'O2 adjusted for body weight was comparable in the four groups. PIP and FI,O2 were higher (Wilcoxon, p<0.01) in the NCLD infants than in those with HMD alone, but MAP was not different. Except for FI,O2, these indices were not different among the infants with NCLD. We conclude that birth weight is the major determinant of the development of neonatal chronic lung disease. At 6 and 12 months corrected age, the abnormal pulmonary function is not associated with prior hyaline membrane disease.