Early prediction of pulmonary outcomes in preterm infants using electrical impedance tomography

Introduction Electrical impedance tomography (EIT) allows assessment of ventilation and aeration homogeneity which may be associated with respiratory outcomes in preterm infants. Methods This was a secondary analysis to a recent randomized controlled trial in very preterm infants in the delivery room (DR). The predictive value of various EIT parameters assessed 30 min after birth on important respiratory outcomes (early intubation <24 h after birth, oxygen dependency at 28 days after birth, and moderate/severe bronchopulmonary dysplasia; BPD) was assessed. Results Thirty-two infants were analyzed. A lower percentage of aerated lung volume [OR (95% CI) = 0.8 (0.66–0.98), p = 0.027] as well as a higher aeration homogeneity ratio (i.e., more aeration in the non-gravity-dependent lung) predicted the need for supplemental oxygen at 28 days after birth [9.58 (5.16–17.78), p = 0.0028]. Both variables together had a similar predictive value to a model using known clinical contributors. There was no association with intubation or BPD, where numbers were small. Discussion In very preterm infants, EIT markers of aeration at 30 min after birth accurately predicted the need for supplemental oxygen at 28 days after birth but not BPD. EIT-guided individualized optimization of respiratory support in the DR may be possible.

[1]  A. Waldmann,et al.  Prophylactic surfactant nebulisation for the early aeration of the preterm lung: a randomised clinical trial , 2022, Archives of Disease in Childhood.

[2]  John B. Tan,et al.  Machine learning for prediction of bronchopulmonary dysplasia-free survival among very preterm infants , 2022, BMC Pediatrics.

[3]  B. Lester,et al.  Bronchopulmonary dysplasia and neurobehavioural outcomes at birth and 2 years in infants born before 30 weeks , 2022, Archives of Disease in Childhood.

[4]  S. Hooper,et al.  Intrapulmonary Volume Changes during Hiccups versus Spontaneous Breaths in a Preterm Infant , 2022, Neonatology.

[5]  P. Davis,et al.  Lung volume distribution in preterm infants on non-invasive high-frequency ventilation , 2022, Archives of Disease in Childhood.

[6]  L. Vedovelli,et al.  Meta-analysis of Lung Ultrasound Scores for Early Prediction of Bronchopulmonary Dysplasia. , 2021, Annals of the American Thoracic Society.

[7]  V. Bhandari,et al.  Diagnosis and management of bronchopulmonary dysplasia , 2021, BMJ.

[8]  A. Waldmann,et al.  The DELUX study: development of lung volumes during extubation of preterm infants , 2021, Pediatric Research.

[9]  S. Pértega-Díaz,et al.  Temporal trends in respiratory care and bronchopulmonary dysplasia in very preterm infants over a 10-year period in Spain , 2021, Archives of Disease in Childhood.

[10]  Y. Elsayed,et al.  Lung Ultrasound for Prediction of Bronchopulmonary Dysplasia in Extreme Preterm Neonates: A Prospective Diagnostic Cohort Study. , 2021, The Journal of pediatrics.

[11]  Lucy T. Greenberg,et al.  Severity of Bronchopulmonary Dysplasia Among Very Preterm Infants in the United States , 2021, Pediatrics.

[12]  Amanda Woods,et al.  Early lung ultrasound affords little to the prediction of bronchopulmonary dysplasia , 2021, Archives of Disease in Childhood.

[13]  A. Concheiro-Guisán,et al.  THE PREDICTIVE VALUE OF LUNG ULTRASOUND SCORES IN DEVELOPING BRONCHOPULMONARY DYSPLASIA: A PROSPECTIVE MULTICENTER DIAGNOSTIC ACCURACY STUDY. , 2021, Chest.

[14]  F. Mosca,et al.  Lung Ultrasound to Monitor Extremely Preterm Infants and Predict BPD: Multicenter Longitudinal Cohort Study. , 2020, American journal of respiratory and critical care medicine.

[15]  P. Davis,et al.  Transmission of Oscillatory Volumes into the Preterm Lung during Noninvasive High-Frequency Ventilation. , 2020, American journal of respiratory and critical care medicine.

[16]  L. Owen,et al.  Regional ventilation characteristics during non-invasive respiratory support in preterm infants , 2020, Archives of Disease in Childhood.

[17]  E. Jensen,et al.  Lifelong pulmonary sequelae of bronchopulmonary dysplasia. , 2020, Current opinion in pediatrics.

[18]  A. Adler,et al.  Electrical Impedance Tomography Can Identify Ventilation and Perfusion Defects: A Neonatal Case , 2019, American journal of respiratory and critical care medicine.

[19]  L. Doyle,et al.  An update on pulmonary and neurodevelopmental outcomes of bronchopulmonary dysplasia. , 2018, Seminars in perinatology.

[20]  Savino Spadaro,et al.  Variation of poorly ventilated lung units (silent spaces) measured by electrical impedance tomography to dynamically assess recruitment , 2018, Critical Care.

[21]  Steffen Leonhardt,et al.  Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group , 2016, Thorax.

[22]  Matthias Kott,et al.  Functional Regions of Interest in Electrical Impedance Tomography: A Secondary Analysis of Two Clinical Studies , 2016, PloS one.

[23]  P. Davis,et al.  Spatiotemporal Aeration and Lung Injury Patterns Are Influenced by the First Inflation Strategy at Birth. , 2016, American journal of respiratory cell and molecular biology.

[24]  N. Ambalavanan,et al.  Biomarkers, Early Diagnosis, and Clinical Predictors of Bronchopulmonary Dysplasia. , 2015, Clinics in perinatology.

[25]  I. Frerichs,et al.  Cross-Sectional Changes in Lung Volume Measured by Electrical Impedance Tomography Are Representative for the Whole Lung in Ventilated Preterm Infants , 2014, Critical care medicine.

[26]  R Core Team,et al.  R: A language and environment for statistical computing. , 2014 .

[27]  N. Marlow,et al.  Clinical prediction models for bronchopulmonary dysplasia: a systematic review and external validation study , 2013, BMC Pediatrics.

[28]  M. Kumar,et al.  Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis , 2013, BMJ.

[29]  J. Hentschel,et al.  Predicting chronic lung disease in very low birthweight infants: Comparison of 3 scores , 1998, Journal of perinatal medicine.