Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Cambridge University Clinical School, Hills Rd, Cambridge, UK.
Pediatr Res. 2023 Nov;94(5):1707-1713. doi: 10.1038/s41390-023-02597-z. Epub 2023 Apr 12.
The main pathophysiologic characteristic of chronic respiratory disease following extremely premature birth is arrested alveolar growth, which translates to a smaller alveolar surface area (S). We aimed to use non-invasive measurements to estimate the S in extremely preterm infants.
Paired measurements of the fraction of inspired oxygen and transcutaneous oxygen saturation were used to calculate the ventilation/perfusion ratio, which was translated to S using Fick's law of diffusion. The S was then adjusted using volumetric capnography.
Thirty infants with a median (range) gestational age of 26.3 (22.9-27.9) weeks were studied. The median (range) adjusted S was 647.9 (316.4-902.7) cm. The adjusted S was lower in the infants who required home oxygen [637.7 (323.5-837.5) cm] compared to those who did not [799.1 (444.2-902.7) cm, p = 0.016]. In predicting the need for supplemental home oxygen, the adjusted S had an area under the receiver operator characteristic curve of 0.815 (p = 0.017). An adjusted S ≥688.6 cm had 86% sensitivity and 77% specificity in predicting the need for supplemental home oxygen.
The alveolar surface area can be estimated non-invasively in extremely preterm infants. The adjusted alveolar surface area has the potential to predict the subsequent need for discharge home on supplemental oxygen.
We describe a novel biomarker of respiratory disease following extremely preterm birth. The adjusted alveolar surface area index was derived by non-invasive measurements of the ventilation/perfusion ratio and adjusted by concurrent measurements of volumetric capnography. The adjusted alveolar surface area was markedly reduced in extremely preterm infants studied at 7 days of life and could predict the need for discharge home on supplemental oxygen. This method could be used at the bedside to estimate the alveolar surface area and provide an index of the severity of lung disease, and assist in monitoring, clinical management and prognosis.
极早产儿慢性呼吸系统疾病的主要病理生理特征是肺泡生长停滞，导致肺泡表面积（S）减小。我们旨在使用非侵入性测量来估计极早产儿的 S。
使用吸入氧分数和经皮氧饱和度的配对测量来计算通气/灌注比，然后使用 Fick 扩散定律将其转换为 S。使用容积二氧化碳图对 S 进行调整。
研究了 30 名中位（范围）胎龄为 26.3（22.9-27.9）周的婴儿。中位（范围）调整后的 S 为 647.9（316.4-902.7）cm。需要家庭吸氧的婴儿的调整后 S [637.7（323.5-837.5）cm] 低于不需要家庭吸氧的婴儿 [799.1（444.2-902.7）cm，p=0.016]。在预测家庭补充氧气的需求时，调整后的 S 的受试者工作特征曲线下面积为 0.815（p=0.017）。调整后的 S≥688.6cm 对预测家庭补充氧气的需求具有 86%的敏感性和 77%的特异性。
极早产儿的肺泡表面积可以通过非侵入性测量来估计。调整后的肺泡表面积有可能预测随后需要补充家庭氧气。
我们描述了一种用于极早产儿慢性呼吸系统疾病的新型生物标志物。通过通气/灌注比的非侵入性测量得出调整后的肺泡表面积指数，并通过同时进行容积二氧化碳图测量进行调整。在出生后 7 天研究的极早产儿中，调整后的肺泡表面积明显减少，可预测家庭补充氧气的需求。这种方法可以在床边使用，估计肺泡表面积并提供肺部疾病严重程度的指标，有助于监测、临床管理和预后。
