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Perinatal lung function measurements and prediction of respiratory problems in infancy
A Greenough1, S Naik, Y Itakura
1Department of Child Health, King's College Hospital, London, UK.
Insights
High airway resistance (R(aw)) and functional residual capacity (FRC) in infants are linked to later respiratory issues. Airway resistance was the most sensitive predictor of these problems.
Area of Science:
- Pediatric Pulmonology
- Neonatal Respiratory Health
- Infant Lung Function
Background:
- Respiratory problems in infancy are a significant concern.
- Identifying early predictors of infant respiratory issues is crucial for timely intervention.
- Lung function testing in the perinatal period may offer predictive insights.
Purpose of the Study:
- To identify which perinatal lung function test best predicts respiratory problems in infancy.
- To evaluate the association between tPTEF:tE, TGV, R(aw), and SG(aw) with infant respiratory symptoms.
Main Methods:
- Examined lung function tests (tPTEF:tE, TGV, R(aw), SG(aw)) in 85 near-term infants.
- Followed infants for one year, classifying them as symptomatic if wheezing occurred for ≥24 hours.
- Utilized logistic regression to determine independent predictors of respiratory symptoms.
Main Results:
- Symptomatic infants had higher functional residual capacity (FRC) and airway resistance (R(aw)), and lower specific airway conductance (SG(aw)).
- The ratio of time to peak expiratory flow to total expiratory time (tPTEF:tE) did not significantly differ between groups.
- High R(aw) (>26 cm H2O (1 s(-1))(-1)) was the most sensitive predictor (83%) of subsequent respiratory problems.
Conclusions:
- High airway resistance (R(aw)) and FRC are independently associated with infant respiratory symptoms.
- While R(aw) shows high sensitivity, all tested parameters had low positive predictive values for infant respiratory problems.
Abstract:
The aim of this study was to determine which lung function test employed in the perinatal period gave the results most significantly associated with respiratory problems in infancy. The ratio of the proportion of time to reach peak tidal expiratory flow to total expiratory time (tPTEF:tE), thoracic gas volume (TGV) and airway resistance (R(aw)) (from which specific conductance (SG(aw)) was calculated) measurements were examined from 85 infants born at or near term. The infants were followed until at least one year of age and described as symptomatic if they wheezed for at least 24 hours. Twenty-three infants were symptomatic in the first year. The symptomatic group, compared to the asymptomatic, had a higher median FRC (p < 0.01) and R(aw) (p < 0.001); their median SG(aw) was lower (p < 0.001). It was possible to obtain tPTEF:tE results from only 61 infants; the median tPTEF:tE did not differ significantly between symptomatic and asymptomatic infants. Logistic regression analysis demonstrated a high R(aw) and FRC, but not a low tPTEF:tE, independently related to positive symptom status. A high R(aw) (>26 cm H2O (1 s(-1))(-1)) was the most sensitive (83%) predictor of subsequent respiratory problems, but all the tests examined had low positive predictive values.