Benjamin Stoecklin, Zeena Al-Obaidi, Jenny Svedenkrans, Raffaele Dellacà, J Jane Pillow
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Diaphragmatic work of breathing per minute was calculated from the inspiratory pressure time integral (PTIdi) and respiratory rate. Factors predictive for each outcome were identified from multivariable linear regression.</p><p><strong>Results: </strong>Very preterm infants (n = 182) were measured at a median (IQR) 35.6 (1.3) weeks' PMA. Infants with BPD had a lower Pdi/V<sub>T</sub> (p = 0.007) and lower PTIdi·min<sup>-1</sup> (p = 0.022) but higher minute ventilation (p = 0.032) and similar respiratory rates (p = 0.419) compared to infants without BPD. Birthweight Z score (R<sup>2</sup> = 0.08, p < 0.001) and BPD (R<sup>2</sup> = 0.04, p = 0.022) were independent negative predictors for Pdi/V<sub>T</sub> while gestational age (R<sup>2</sup> = 0.04, p = 0.01) and average early postnatal energy intake (R<sup>2</sup> = 0.03, p = 0.026) were independent positive predictors for PTIdi·min<sup>-1</sup> on multivariable analysis. Chorioamnionitis and duration of mechanical ventilation did not contribute to the final model.</p><p><strong>Conclusions: </strong>Contrary to our hypothesis, diaphragm functional effectiveness appears improved in infants with BPD. We speculate this finding may reflect an adaptive process, or alternatively indicate an increased recruitment of accessory muscles to achieve required ventilation in BPD infants. 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Moreover, diaphragmatic functional effectiveness is influenced by adverse antenatal and postnatal factors.</p><p><strong>Methodology: </strong>Diaphragmatic functional effectiveness was assessed in a single-centre, prospective observational study in preterm infants. Transdiaphragmatic pressure (Pdi) and respiratory flow were measured during quiet sleep at 36 weeks' postmenstrual age (PMA). Pdi was normalized to tidal volume (Pdi/V<sub>T</sub>). Diaphragmatic work of breathing per minute was calculated from the inspiratory pressure time integral (PTIdi) and respiratory rate. Factors predictive for each outcome were identified from multivariable linear regression.</p><p><strong>Results: </strong>Very preterm infants (n = 182) were measured at a median (IQR) 35.6 (1.3) weeks' PMA. 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引用次数: 0
摘要
目的：了解支气管肺发育不良（BPD）及产前和产后因素如何影响极早产儿膈功能的有效性。工作假设：BPD婴儿自发性呼吸时膈肌功能有效性受损。此外，膈肌功能的有效性受到产前和产后不利因素的影响。方法：在一项针对早产儿的单中心前瞻性观察研究中评估膈肌功能的有效性。经后36周安静睡眠时测量经膈压（Pdi）和呼吸流量。将Pdi归一化为潮气量（Pdi/VT）。通过吸气压力时间积分（PTIdi）和呼吸频率计算每分钟呼吸的膈肌功。通过多变量线性回归确定每个结果的预测因素。结果：极早产儿（n = 182）的中位胎压（IQR）为35.6（1.3）周。BPD患儿的Pdi/VT较低（p = 0.007）， PTIdi·min-1较低（p = 0.022），但分钟通气量较高（p = 0.032），呼吸频率相似（p = 0.419）。多变量分析显示，出生体重Z评分（R2 = 0.08, p 2 = 0.04, p = 0.022）是Pdi/VT的独立阴性预测因子，胎龄（R2 = 0.04, p = 0.01）和出生后早期平均能量摄入（R2 = 0.03, p = 0.026）是PTIdi·min-1的独立阳性预测因子。绒毛膜羊膜炎和机械通气时间对最终模型没有影响。结论：与我们的假设相反，横膈膜功能的有效性在BPD婴儿中得到改善。我们推测这一发现可能反映了一个适应性过程，或者表明BPD婴儿增加了辅助肌肉的招募以达到所需的通气。不利的产前和产后因素只能解释隔膜有效性差异的一小部分。
Diaphragm Function in Very Preterm Infants at 36 Weeks' Postmenstrual Age.
Objectives: Understand how bronchopulmonary dysplasia (BPD) and antenatal and postnatal factors influence diaphragmatic functional effectiveness in very preterm infants.
Working hypothesis: Diaphragmatic functional effectiveness during spontaneous breathing is impaired in infants with BPD. Moreover, diaphragmatic functional effectiveness is influenced by adverse antenatal and postnatal factors.
Methodology: Diaphragmatic functional effectiveness was assessed in a single-centre, prospective observational study in preterm infants. Transdiaphragmatic pressure (Pdi) and respiratory flow were measured during quiet sleep at 36 weeks' postmenstrual age (PMA). Pdi was normalized to tidal volume (Pdi/VT). Diaphragmatic work of breathing per minute was calculated from the inspiratory pressure time integral (PTIdi) and respiratory rate. Factors predictive for each outcome were identified from multivariable linear regression.
Results: Very preterm infants (n = 182) were measured at a median (IQR) 35.6 (1.3) weeks' PMA. Infants with BPD had a lower Pdi/VT (p = 0.007) and lower PTIdi·min-1 (p = 0.022) but higher minute ventilation (p = 0.032) and similar respiratory rates (p = 0.419) compared to infants without BPD. Birthweight Z score (R2 = 0.08, p < 0.001) and BPD (R2 = 0.04, p = 0.022) were independent negative predictors for Pdi/VT while gestational age (R2 = 0.04, p = 0.01) and average early postnatal energy intake (R2 = 0.03, p = 0.026) were independent positive predictors for PTIdi·min-1 on multivariable analysis. Chorioamnionitis and duration of mechanical ventilation did not contribute to the final model.
Conclusions: Contrary to our hypothesis, diaphragm functional effectiveness appears improved in infants with BPD. We speculate this finding may reflect an adaptive process, or alternatively indicate an increased recruitment of accessory muscles to achieve required ventilation in BPD infants. Adverse antenatal and postnatal factors only explain a small proportion of variance in diaphragm effectiveness.
期刊介绍：
Pediatric Pulmonology (PPUL) is the foremost global journal studying the respiratory system in disease and in health as it develops from intrauterine life though adolescence to adulthood. Combining explicit and informative analysis of clinical as well as basic scientific research, PPUL provides a look at the many facets of respiratory system disorders in infants and children, ranging from pathological anatomy, developmental issues, and pathophysiology to infectious disease, asthma, cystic fibrosis, and airborne toxins. Focused attention is given to the reporting of diagnostic and therapeutic methods for neonates, preschool children, and adolescents, the enduring effects of childhood respiratory diseases, and newly described infectious diseases.
PPUL concentrates on subject matters of crucial interest to specialists preparing for the Pediatric Subspecialty Examinations in the United States and other countries. With its attentive coverage and extensive clinical data, this journal is a principle source for pediatricians in practice and in training and a must have for all pediatric pulmonologists.
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