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Chest wall motion in preterm infants using respiratory inductive plethysmography
R H Warren1, S M Horan, P K Robertson
1Dept of Pediatrics, University of Arkansas for Medical Sciences, and Arkansas Children's Hospital, Little Rock, USA.
Insights
Preterm infants exhibit significantly greater chest wall and abdomen asynchrony during breathing compared to full-term infants. This study used respiratory inductive plethysmography to objectively assess preterm infant chest wall motion.
Area of Science:
- Neonatal physiology
- Respiratory mechanics
- Infant development
Background:
- Preterm infant thoracic structures differ from those of healthy full-term infants, potentially altering tidal breathing patterns.
- Objective bedside assessment of chest wall motion in preterm infants is needed for better understanding and management.
Purpose of the Study:
- To describe chest wall motion in preterm infants (gestational age <37 weeks).
- To compare chest wall motion in preterm infants with that of healthy, full-term infants.
- To evaluate the utility of respiratory inductive plethysmography for bedside assessment.
Main Methods:
- Sixty-one preterm infants (mean postconceptional age 35.3 weeks) and a group of healthy, full-term infants were studied.
- Chest wall motion was assessed using a noninvasive, semiquantitatively calibrated respiratory inductive plethysmograph.
- Infants were studied in a quiet, awake, prone position to minimize disruption.
Main Results:
- Preterm infants showed a significantly greater mean phase angle (60.6 vs. 12.5 degrees) and laboured breathing index (1.35 vs. 1.01) compared to full-term infants (p < 0.0001 and p = 0.001, respectively).
- Ribcage contribution to breathing did not significantly differ between groups (25.5% vs. 36.3%, p = 0.11).
- A significant increase in ribcage and abdomen asynchrony was observed in preterm infants.
Conclusions:
- Preterm infants demonstrate increased chest wall and abdominal asynchrony during tidal breathing.
- Respiratory inductive plethysmography is an effective, objective, and time-efficient method for assessing chest wall motion in preterm infants.
Abstract:
Preterm infant tidal breathing may be different from that of healthy full-term infants because of various features of the premature thorax. The purpose of this project was to describe chest wall motion in the preterm infant (gestational age <37 weeks) and compare it with chest wall motion data in a group of healthy, full-term infants. We wanted to use an objective bedside method for assessment with minimal disruption to the infant. The study population consisted of 61 preterm human infants whose mean(+/-sD) postconceptional age at time of study was 35.3+/-2.1 weeks. During the study, the infants were quietly awake in a prone position. Preterm infants had initially been admitted to a level III neonatal intensive care unit for acute management and had been transferred to a step-down area, where they were in stable condition for study. Data were collected with a semiquantitatively calibrated, noninvasive respiratory inductive plethysmograph. Mean(+/-SD) phase angle was significantly greater in preterm infants than in full-term infants (60.6+/-39.8 degrees versus 12.5+/-5.0 degrees, respectively, p < or = 0.0001). The laboured breathing index was significantly greater in preterm infants than in full-term infants (1.35+/-0.35 versus 1.01+/-0.01, respectively, p = 0.001). The ribcage contribution to breathing did not differ significantly between preterm and full-term infants (25.5+/-17.7% versus 36.3+/-14.4%, respectively, p = 0.11). These results indicate a significant increase in the degree of ribcage and abdomen asynchrony in the preterm subjects compared to the full-term infants. Plethysmography provided a time-efficient and objective method of assessing chest wall motion in this fragile population.