Clinical Research Article | Published:

Oscillatory respiratory mechanics on the first day of life improves prediction of respiratory outcomes in extremely preterm newborns

Pediatric Researchvolume 85pages312317 (2019) | Download Citation

Subjects

Abstract

Background

We aimed to evaluate if lung mechanics measured by forced oscillatory technique (FOT) during the first day of life help identify extremely low gestational age newborns (ELGANs) at risk of prolonged mechanical ventilation (MV) and oxygen dependency.

Methods

Positive end-expiratory pressure (PEEP) was increased 2 cmH2O above the clinically set PEEP, then decreased by four 5-min steps of 1 cmH2O, and restored at the clinical value. At each PEEP, FOT measurements were performed bedside during MV. Changes in respiratory mechanics with PEEP, clinical parameters, and chest radiographs were evaluated.

Results

Twenty-two newborns (24+4 ± 1+4 wks gestational age (GA); birth weight 653 ± 166 g) on assist/control ventilation were studied. Infants were ventilated for 40 ± 36 d (range 1–155 d), 11 developed severe bronchopulmonary dysplasia (BPD) and one died before 28 d. Early lung mechanics correlated with days on MV, days of respiratory support, and BPD grade. Effects of increasing PEEP on oscillatory reactance assessed by FOT together with GA and radiographic score predicted days on MV (multilinear model, r2 = 0.73). A logistic model considering the same FOT parameter together with GA predicts BPD development.

Conclusions

FOT can be applied bedside in ELGANs, where early changes in lung mechanics with PEEP improve clinical prediction of respiratory outcomes.

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Acknowledgements

The authors would like to thank Drs. Eva Penno, MD PhD, and Peter Pech, MD PhD, at the Department of Radiology, Uppsala University Children’s Hospital, Uppsala, for assistance in the evaluation of radiographs. The authors gratefully acknowledge MarJanna Dahl of the University of Utah for revising the manuscript. This study was supported by grants from the Her Royal Highness Crown Princess Lovisa’s Foundation for Children’s Health Care, Stockholm and the Gillbergska Foundation, Uppsala. The study sponsors had no role in the design of the study, the collection, analysis, or interpretation of data, the writing of the report or the decision to submit the manuscript for publication.

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Author notes

  1. These authors contributed equally: Chiara Veneroni and Linda Wallstrom.

Affiliations

  1. Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milan, Italy

    • Chiara Veneroni
    •  & Raffaele L. Dellacaʼ
  2. Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden

    • Linda Wallström
    •  & Richard Sindelar

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Contributions

C.V. contributed to the study design and to the experimental activity, carried out data processing and analysis, and drafted the manuscript. L.W. contributed to the study design, took part to the experimental activity, carried out data analysis, and contributed to drafting the manuscript. R.S. contributed to study design, data interpretation, and critically revised the manuscript. R.L.D. contributed to the study design, data interpretation, and in writing the manuscript. All authors read and approved the final manuscript.

Competing interests

The authors have no conflicts of interest. Politecnico di Milano University, institution of C.V. and R.L.D., received research grants from Chiesi Farmaceutici SpA, Acutronic Medical Systems AG, and Philips. Politecnico di Milano also licensed patents on diagnostic application of the forced oscillation technique to Acutronic Medical Systems AG and Philips.

Corresponding author

Correspondence to Chiara Veneroni.

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DOI

https://doi.org/10.1038/s41390-018-0133-6