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Lung function measurement in prematurely born preschool children with and without chronic lung disease

Abstract

Objective:

Prematurely born infants often have recurrent wheeze and long-term respiratory morbidity at follow-up. Assessment of airways obstruction in preschool children is feasible using the interrupter resistance (Rint) but has rarely been examined in preterm children with and without chronic lung disease (CLD). The objective of this study was to determine lung function measured by the interrupter technique, its feasibility in the ambulatory setting and respiratory health in prematurely born preschool children with and without CLD.

Study Design:

Preterm children of 2 to 4 years with severe CLD (>30% oxygen at 36 weeks and discharged home receiving supplemental oxygen) (n=43, median gestational age 27 weeks and median birth weight 995 g) and without CLD (n=33, median gestational age 29 weeks and median birth weight 1366 g) attempting lung function test for the first time were enrolled. Respiratory symptoms score was calculated using a questionnaire. A single set of 10 consecutive Rint measurements was obtained using a portable device (MicroRint). Median of at least five occlusions with consistent shape of mouth pressure–time curves was taken to be a Rint measurement. To assess feasibility the children were categorized as ‘satisfactory’, ‘failure’ and ‘rejected’ depending on the outcome of the test. Outcome variables were respiratory symptoms score and Rint.

Result:

Satisfactory Rint measurement was obtained in 46 (61%) children, 9 (36%) 2-year olds, 17 (65%) 3-year olds and 20 (80%) 4-year olds. As compared with the preterm control children (n=18), CLD children (n=28) had significantly higher respiratory symptoms score (18.5 vs 6, P<0.01) and Rint expressed as absolute values (kPa l−1) and z-scores (1.33 vs 1.16 and 1.42 vs 1.0, P<0.01), respectively.

Conclusion:

Rint measurement is feasible in prematurely born children of preschool age in the ambulatory setup. Preschool children with severe CLD may be identified from preterm children without CLD by increased Rint that may be used as a screening tool and as an outcome measure for interventions.

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References

  1. Allen J, Zwerdling R, Ehrenkranz R, Gaultier C, Geggel R, Greenough A et al. Statement on the care of the child with chronic lung disease of infancy and childhood. Am J Respir Crit Care Med 2003; 168: 356–396.

    Article  Google Scholar 

  2. Bancalari E, Claure N, Sosenko IR . Bronchopulmonary dysplasia: changes in pathogenesis, epidemiology and definition. Semin Neonatol 2003; 8: 63–71.

    Article  Google Scholar 

  3. Gross SJ, Iannuzzi DM, Kveselis DA, Anbar RD . Effect of preterm birth on pulmonary function at school age: a prospective controlled study. J Pediatr 1998; 133: 188–192.

    Article  CAS  Google Scholar 

  4. Northway Jr WH, Moss RB, Carlisle KB, Parker BR, Popp RL, Pitlick PT et al. Late pulmonary sequelae of bronchopulmonary dysplasia. N Engl J Med 1990; 323: 1793–1799.

    Article  Google Scholar 

  5. Pelkonen A, Hakulinen A, Turpeinen M . Bronchial lability and responsiveness in school children born very preterm. Am J Respir Crit Care Med 1997; 156: 1178–1184.

    Article  CAS  Google Scholar 

  6. Smyth J, Tabachnik E, Duncan WJ, Reilly BJ, Levison H . Pulmonary function and bronchial hyperreactivity in long-term survivors of bronchopulmonary dysplasia. Pediatrics 1981; 68: 336–340.

    CAS  PubMed  Google Scholar 

  7. Greenough A, Giffin FJ, Yuksel B . Respiratory morbidity in preschool children born prematurely. Relationship to adverse neonatal events. Acta Paediatr 1996; 85: 772–777.

    Article  CAS  Google Scholar 

  8. Snepvangers Y, Peter de Winter JP, Burger H, Brouwers H, Van der Ent CK . Neonatal respiratory mechanics and development of bronchial hyperresponsiveness in preterm infants. Early Hum Dev 2004; 78: 105–118.

    Article  Google Scholar 

  9. Carter ER, Stecenko AA, Pollock BH, Jaeger MJ . Evaluation of the interrupter technique for the use of assessing airway obstruction in children. Pediatr Pulmonol 1994; 17: 211–217.

    Article  CAS  Google Scholar 

  10. Bridge PD, Ranganathan S, Mckenzie SA . Measurement of airway resistance using the interrupter technique in preschool children in the ambulatory setting. Eur Respir J 1999; 13: 792–796.

    Article  CAS  Google Scholar 

  11. Merkus PJ, Mijnsbergen JY, Hop WC, de Jongste JC . Interrupter Resistance in preschool children: measurement characteristics and reference values. Am J Respir Crit Care Med 2001; 163: 1350–1355.

    Article  CAS  Google Scholar 

  12. Beydon N, Amsallem F, Bellet M, Boule M, Chaussain M, Denjean A et al. Pulmonary function tests in preschool children with cystic fibrosis. Am J Respir Crit Care Med 2002; 166: 1099–1104.

    Article  Google Scholar 

  13. Jobe AH, Bancalari E . Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163: 1723–1729.

    Article  CAS  Google Scholar 

  14. Powell CV, McNamara P, Solis A, Shaw NJ . A parent completed questionnaire to describe the patterns of wheezing and other respiratory symptoms in infants and preschool children. Arch Dis Child 2002; 87: 376–379.

    Article  CAS  Google Scholar 

  15. Chowienczyk PJ, Lawson CP, Lane S, Johnson R, Wilson N, Silverman M et al. A flow interruption device for the measurement of airway resistance. Eur Respir J 1991; 4: 623–628.

    CAS  PubMed  Google Scholar 

  16. Bridge PD, McKenzie SA . Airway resistance measured by the interrupter technique: expiration or inspiration, mean or median? Eur Respir J 2001; 17: v495–v498.

    Article  Google Scholar 

  17. McKenzie SA, Chan E, Dundas I, Bridge PD, Pao CS, Mylonopoulou M et al. Airway resistance measured by the interrupter technique: normative data for 2–10 year olds of three ethnicities. Arch Dis Child 2002; 87: v248–v251.

    Article  Google Scholar 

  18. Phagoo SB, Wilson NM, Silverman M . Evaluation of a new interrupter device for measuring bronchial responsiveness and the response to bronchodilator in 3 year old children. Eur Respir J 1996; 9: 1374–1380.

    Article  CAS  Google Scholar 

  19. Veugelers R, Penning C, Grootscholten SP, Merkus PJ, Arets HG, Rieken R et al. Should we use criteria or eyeballing to reject post-interruption tracings? Pediatr Pulmonol 2006; 41: 937–946.

    Article  Google Scholar 

  20. Phagoo SB, Watson RA, Pride NB, Silverman M . Accuracy and sensitivity of the interrupter technique for measuring the response to bronchial challenge in normal subjects. Eur Respir J 1993; 6: 996–1003.

    CAS  PubMed  Google Scholar 

  21. Frey U, Kraemer R . Oscillatory pressure transients after flow interruption during bronchial challenge test in children. Eur Respir J 1997; 10: 75–81.

    Article  CAS  Google Scholar 

  22. Bridge PD, Wertheim D, Jackson AC, McKenzie SA . Pressure oscillation amplitude after interruption of tidal breathing as an index of change in airway mechanics in preschool children. Pediatr Pulmonol 2005; 40: 420–425.

    Article  Google Scholar 

  23. Gappa M, Pillow JJ, Allen J, Mayer O, Stocks J . Lung function tests in neonates and infants with chronic lung disease: lung and chest-wall mechanics. Pediatr Pulmonol 2006; 41: 291–317.

    Article  Google Scholar 

  24. Cano A, Payo F . Lung function and airway responsiveness in children and adolescents after hyaline membrane disease: a matched cohort study. Eur Respir J 1997; 10: 880–885.

    CAS  PubMed  Google Scholar 

  25. Malmberg LP, Mieskonen S, Pelkonen A, Kari A, Sovijarvi AR, Turpeinen M . Lung function measured by the oscillometric method in prematurely born children with chronic lung disease. Eur Respir J 2000; 16: 598–603.

    Article  CAS  Google Scholar 

  26. Vrijlandt EJ, Boezen HM, Gerritsen J, Stremmelaar EF, Duiverman EJ . Respiratory health in prematurely born preschool children with and without bronchopulmonary dysplasia. J Pediatr 2007; 150: 256–261.

    Article  CAS  Google Scholar 

  27. Kessler V, Mols G, Bernhard H, Haberthur C, Guttman J . Interrupter airway and tissue resistance: errors caused by valve properties and respiratory system compliance. J Appl Physiol 1999; 87 (4): 1546–1554.

    Article  CAS  Google Scholar 

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Acknowledgements

We acknowledge the contributions to this study by the asthma fund at the Royal Liverpool Children's Hospital, Liverpool, UK.

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Correspondence to V R Kairamkonda.

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Kairamkonda, V., Richardson, J., Subhedar, N. et al. Lung function measurement in prematurely born preschool children with and without chronic lung disease. J Perinatol 28, 199–204 (2008). https://doi.org/10.1038/sj.jp.7211911

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