Respiratory Compliance of Newborns after Birth and Its Prognostic Value for the Course and Outcome of Respiratory Disease

Abstract

The compliance of the respiratory system was determined at an average of 2.89 h (range 45 min – 8 h) after birth in 82 newborns who were retrospectively divided into group 1: healthy newborns (mean gestational age 37.1 weeks, range 30–41 weeks); group 2: newborns with respiratory distress (RD) needing no ventilatory support (mean gestational age 37.3 weeks, range 35–40 weeks); group 3: newborns with RD needing ventilatory support and surviving (mean gestational age 34.3 weeks, range 30 – 39 weeks), and group 4: newborns with RD who needed ventilatory support and died (mean gestational age 30’.8 weeks, range 28 – 37 weeks). Respiratory compliance was measured by the airway occlusion technique in spontaneously breathing babies and by injecting a known volume of gas into the closed airway system and measuring airway pressure in intubated babies. The difference in postnatal compliance was statistically significant (p < 0.01) in those four groups and was correlated with the severity of the disease in groups 2 and 3. In infants with RD, compliance was highly predictive for the need for ventilatory support (93% correct and 7% erroneous) and in infants with ventilatory support, for the mortality (83% correct and 17% erroneous). We conclude that postnatal compliance measurements are very useful to predict the course and outcome as well as to classify the severity of RD.

Respiratory mechanics in ventilated preterm infants: early determinants and outcome

“…24 This was supported by the findings of Robertson and colleagues in 1964, who found thickened alveolar walls with an increase of fibroblasts and excess of reticulin or collagen fibres, and radiological abnormalities, like emphysematous blebs and patchy infiltrates changing to small areas of atelectases in these infants. 219 In 1967, Northway and colleagues described the clinical, histological and radiological features of this pulmonary disease following respiratory therapy of RDS and they called it bronchopulmonary dysplasia (BPD). 197 These infants developed severe RDS for which they required high FiO2 and prolonged mechanical ventilation with high positive airway pressures.…”

“…Results relating these parameters to respiratory outcome are conflicting, particularly with regard to the development of CLD. 19,70,89,91,137,160,219,256 Moreover, most of these studies were performed before the use of prenatal corticosteroids and the introduction of exogenous surfactant therapy. As a consequence of these recent developments in perinatal care, the survival of more immature infants has increased.…”

“…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.…”

Ultrasound Assessment of Ex Vivo Lung Tissue Properties Using a Fluid-Filled Negative Pressure Bath

“…Higher pressures are required to inflate the lung, increasing the work of breathing. The measurement of pulmonary compliance can have important diagnostic and prognostic value, although its measurement can be technically challenging [4][5][6]. In order to calculate compliance, volume change is measured with a spirometer and esophageal pressure is used as a surrogate for intrapleural pressure.…”

Respiratory outcome in preterm ventilated infants: importance of early respiratory system resistance

“…Results relating these parameters to respiratory outcome are conflicting, particularly with regard to the development of CLD [2,11,14,15,18,22,27,31]. Moreover, most of these studies were performed before the use of prenatal corticosteroids and the introduction of exogenous surfactant therapy.…”