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Association of prematurity, lung disease and body size with lung volume and ventilation inhomogeneity in unsedated neonates: a multicentre study
  1. Georg Hülskamp (hulskamp{at}uni-muenster.de)
  1. University of Münster and Clemenshospital, Germany
    1. Sooky Lum (s.lum{at}ich.ucl.ac.uk)
    1. Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, UCL, Institute of Child Health, United Kingdom
      1. Janet Stocks (j.stocks{at}ich.ucl.ac.uk)
      1. Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, UCL, Institute of Child Health, United Kingdom
        1. Angie Wade (a.wade{at}ich.ucl.ac.uk)
        1. Paediatric Epidemiology and Biostatistics Unit, UCL, Institute of Child Health, London, United Kingdom
          1. Ah-fong Hoo (a.hoo{at}ich.ucl.ac.uk)
          1. Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, UCL, Institute of Child Health, United Kingdom
            1. Kate Costeloe (k.l.costeloe{at}qmul.ac.uk)
            1. Academic Unit of Paediatrics, Barts and the London School of Medicine and Dentistry, Neonatal Unit, United Kingdom
              1. Jane Hawdon (jane.hawdon{at}uclh.nhs.uk)
              1. Neonatal Unit, University College London Hospital, London, United Kingdom
                1. Kandadai Deeptha (deeptk01{at}student.uwa.edu.au)
                1. School of Women's and Infants' Health, University of Western Australia, Perth, Australia
                  1. J Jane Pillow (jpillow{at}meddent.uwa.edu.au)
                  1. School of Women's and Infants' Health, University of Western Australia, Perth, Australia

                    Abstract

                    Background: Previous studies have suggested that preterm birth with or without subsequent chronic lung disease is associated with reduced functional residual capacity (FRC) and increased ventilation inhomogeneity in the neonatal period. We aimed to establish whether such findings are associated with the degree of prematurity, neonatal respiratory illness, and disproportionate somatic growth.

                    Methods: Multiple breath washout measurements using an ultrasonic flowmeter were obtained from 219 infants on 306 test occasions, during the first few months of life, at three neonatal units in the United Kingdom and Australia. Tests were performed during unsedated sleep in clinically stable infants (assigned to four exclusive diagnostic categories: term controls, preterm controls, respiratory distress syndrome and chronic lung disease). The determinants of neonatal lung function were assessed using multivariable, multilevel modelling.

                    Results: After adjustment for age and body proportions, the factors gestation, intrauterine growth restriction and days of supplemental oxygen were all significantly associated with a reduced FRC. In contrast, increased ventilation inhomogeneity (elevated Lung Clearance Index) was only significantly associated with duration of supplemental oxygen. After adjusting for continuous variables, diagnostic category made no further contribution to the models. Despite using identical techniques, unexpected inter-centre differences occurred, associated with the equipment used; these did not alter the negative association of preterm delivery and disease severity with lung function outcomes.

                    Conclusion: Reduction in FRC is independently associated with prematurity, intrauterine growth restriction and severity of neonatal lung disease. Determinants of lung function shortly after birth are highly complex in different disease groups.

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