Pulmonary function at 1 year of age in survivors of neonatal respiratory distress: A multivariate analysis of factors associated with sequelae

Abstract

We studied pulmonary function 1 year after neonatal respiratory distress (RD) in 54 infants who had been treated at birth in the same neonatal intensive care unit. RD was related to hyaline membrane disease in 36 cases (group I) and to other causes in 18 cases (group II). Compared with predicted values, dynamic lung compliance (CL) was lower (less than -2 SD) and total pulmonary resistance (RL) was higher (+2 SD) in 18 (33%) and 12 (22%) infants, respectively. The relationships between these functional abnormalities at 1 year of age and the characteristics of the neonatal respiratory disease were assessed using a multifactorial analysis (multiple correspondences analysis). We found that elevated RL (greater than +2 SD) at 1 year of age was very significantly related with hyaline membrane disease, involving both high rate of positive pressure ventilation and prolonged intubation, and with the presence of both tachypnea and abnormal chest X rays at the time of discharge. Compared with elevated RL, the relationships between low CL (less than -2 SD) and the same neonatal characteristics were less significant; in particular, there was no strong link between low CL and hyaline membrane disease. Finally, birth before 30 weeks gestation was an index of severity.

Success rate and neonatal morbidities associated with early extubation in extremely low birth weight infants

“…However, prolonged mechanical ventilation in extremely low birth weight (ELBW) infants increases the risk of serious complications, including bronchopulmonary dysplasia (BPD),1 subglottic stenosis,23 infection, and mortality 4…”

Respiratory mechanics in ventilated preterm infants: early determinants and outcome

“…Contractile forces of the airway smooth muscle, geometry of the airways, and impedance against which the airway smooth muscle must contract (cartilage and elastic recoil of the lung) change with age and affect airway reactivity. 179 Additionally, forces of interdependence between pulmonary airways and parenchyma increase with age, limiting airway narrowing, 252 and the number of cholinergic muscarinic receptors and their affinity for muscarinic agonists decrease with age while airway acetylcholinesterase activity increases. 176 …”

“…9,224 In preterm infants, neonatal respiratory system compliance (Crs) and resistance (Rrs) are indicative of long-term respiratory morbidity, 30,85,151,153,179,193 which may reflect BHR during childhood. 174,181,195,223 More information about causal factors of BHR development is needed to elucidate the pathological process of BHR development in preterm infants.…”

“…In the past, neonatal and childhood respiratory function have been studied extensively in relation to preterm birth 78,94,179,193,243 , CLD development 15,19,70,85,89,91,137,160,193,219,256 , and neonatal therapeutic interventions. 94,151,196,275 Only one of these studies consequently performed serial respiratory function measurements in 24 infants, who developed CLD, during the first 2 years of life commencing in the neonatal period.…”

Use of Preestablished Criteria for Deciding on Extubation in the Very Low Birthweight Newborn

“…In applying these principles, we observed, as others have done [2,3] that 11 % of cases of BPD in VLBW fol low ventilation for apnea. This observation, and the possibility that tracheal intubation itself plays a role in the occurrence of pulmo nary lesions [4], incited us to seek ways of achieving earlier weaning from MV in VLBW while nevertheless guarding against severe ap nea. The use of doxapram concomitantly with caffeine [5,6] seemed likely to fulfill this role.…”