Use of pulse oscillometry for pulmonary function testing in premature infants

Use of pulse oscillometry for pulmonary function testing in premature infants

Infants born prematurely remain vulnerable to numerous health complications such as respiratory distress syndrome, chronic lung disease and pulmonary dysfunction. In addition, extremely low gestational age newborns (ELGANs) or babies born more than 3 months before the expected date of birth (gestational age < 29 weeks) are at higher risk of developing bronchopulmonary dysplasia (BPD), a breathing disorder in which the infants' lungs are irritated and do not develop normally. A careful assessment of lung function is therefore crucial for monitoring the respiratory system in such cases Premature babies.

Existing methods for assessing lung function such as spirometry are limited by the need for forced exhalation. While impulse oscillometry (IOS), a non-invasive alternative, allows measurement of pulmonary respiratory mechanics without the need for forced exhalation, there is no report of an effective multicenter study design using IOS to assess pulmonary function in ELGANs.

A recent study conducted by researchers from the Department of Pediatrics at the Children's Hospital of Philadelphia, USA, and published inPediatric examinationon September 25, 2024 sheds important light on the suitability of IOS for testing lung function in a large multicenter ELGAN population. “Despite the non-invasive nature of IOS, this is not the casebeenCommonly used to assess lung health in the ELGAN population. That motivated us to do itreport on our methods and successes implementa multicenter protocol to obtain research-quality oscillometry data in extremely preterm infants,”explains Dr. Katharine Tsukahara, the study's lead author.

In their study, researchers recruited early school-age preterm infants at high risk of BPD from the Hydrocortisone for Bronchopulmonary Dysplasia Respiratory and Developmental (HYBRiD) Outcomes Study, as well as early school-age preterm infants with minimal BPD or no lung disease from the Early School Age Transfusion of Prematures Follow-up Study (TOP 5). In addition, full-term children with healthy lungs were used to allow an effective comparison between different study groups.

A 6-minute walk test and the International Study of Asthma and Allergies in Childhood questionnaire were used at five Neonatal Research Network (NRN) centers to assess the respiratory function of study participants. IOS was performed according to Childhood Asthma Research and Education (CARE) Network procedures. To ensure the research quality of the oscillometry data, the IOS reports were reviewed against five quality criteria from the CARE Network for Oscillometry Studies in Pediatric Asthma.

Around 98% of study participants attempted the oscillometry test. The technical acceptance of IOS was high in all three study groups, varying between 85% and 90% of the tests attempted. Furthermore, acceptance remained high in the five NRN centers.“The increased success in the ‘real world’ – the percentage of tests that met the research quality criteria in our study design – can be attributed to rigorous in-person training in conducting IOS, careful review of data quality, and timely investigator involvement.” Meeting to identify and address challenges related to IOS testing,”explains Dr. Tsukahara noted the high success rates of IOS in her study.

In addition, researchers examined whether a clinical factor affected the likelihood of producing acceptable oscillometry data in the study population. They found that lower birth weight, number of days requiring ventilation during the neonatal intensive care unit, and neuromotor comorbidities were associated with a higher failure rate on IOS testing.

"Currently, there is limited clinical data on lung health outcomes in former preterm infants. Our team's study design has demonstrated a high level of success and acceptability in generating research-quality IOS data in a population with high rates of prematurity-associated comorbidities." Study provides a possible framework for future research studies examining lung function in formerly preterm infants.”concludes Dr. Tsukahara and underlines the importance of the present study.

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