Stoecklin Benjamin, Al-Obaidi Zeena, Svedenkrans Jenny, Dellacà Raffaele, Pillow J Jane
School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia.
Department of Neonatology, University Children's Hospital Basel (UKBB), Basel, Switzerland.
Pediatr Pulmonol. 2025 May;60(5):e71121. doi: 10.1002/ppul.71121.
Understand how bronchopulmonary dysplasia (BPD) and antenatal and postnatal factors influence diaphragmatic functional effectiveness in very preterm infants.
Diaphragmatic functional effectiveness during spontaneous breathing is impaired in infants with BPD. Moreover, diaphragmatic functional effectiveness is influenced by adverse antenatal and postnatal factors.
Diaphragmatic functional effectiveness was assessed in a single-centre, prospective observational study in preterm infants. Transdiaphragmatic pressure (Pdi) and respiratory flow were measured during quiet sleep at 36 weeks' postmenstrual age (PMA). Pdi was normalized to tidal volume (Pdi/V). Diaphragmatic work of breathing per minute was calculated from the inspiratory pressure time integral (PTIdi) and respiratory rate. Factors predictive for each outcome were identified from multivariable linear regression.
Very preterm infants (n = 182) were measured at a median (IQR) 35.6 (1.3) weeks' PMA. Infants with BPD had a lower Pdi/V (p = 0.007) and lower PTIdi·min (p = 0.022) but higher minute ventilation (p = 0.032) and similar respiratory rates (p = 0.419) compared to infants without BPD. Birthweight Z score (R = 0.08, p < 0.001) and BPD (R = 0.04, p = 0.022) were independent negative predictors for Pdi/V while gestational age (R = 0.04, p = 0.01) and average early postnatal energy intake (R = 0.03, p = 0.026) were independent positive predictors for PTIdi·min on multivariable analysis. Chorioamnionitis and duration of mechanical ventilation did not contribute to the final model.
Contrary to our hypothesis, diaphragm functional effectiveness appears improved in infants with BPD. We speculate this finding may reflect an adaptive process, or alternatively indicate an increased recruitment of accessory muscles to achieve required ventilation in BPD infants. Adverse antenatal and postnatal factors only explain a small proportion of variance in diaphragm effectiveness.
了解支气管肺发育不良（BPD）以及产前和产后因素如何影响极早产儿的膈肌功能效率。
BPD婴儿在自主呼吸时膈肌功能效率受损。此外，膈肌功能效率受产前和产后不良因素影响。
在一项针对早产儿的单中心前瞻性观察研究中评估膈肌功能效率。在孕龄（PMA）36周安静睡眠期间测量跨膈压（Pdi）和呼吸流量。Pdi除以潮气量（Pdi/V）进行标准化。每分钟的膈肌呼吸功由吸气压力时间积分（PTIdi）和呼吸频率计算得出。通过多变量线性回归确定每个结果的预测因素。
在PMA中位数（四分位间距）为35.6（1.3）周时对182例极早产儿进行了测量。与无BPD的婴儿相比，BPD婴儿的Pdi/V较低（p = 0.007），PTIdi·min较低（p = 0.022），但分钟通气量较高（p = 0.032），呼吸频率相似（p = 0.419）。出生体重Z评分（R = 0.08，p < 0.001）和BPD（R = 0.04，p = 0.022）是Pdi/V的独立负性预测因素，而胎龄（R = 0.04，p = 0.01）和出生后早期平均能量摄入量（R = 0.03，p = 0.026）是多变量分析中PTIdi·min的独立正性预测因素。绒毛膜羊膜炎和机械通气持续时间未纳入最终模型。
与我们的假设相反，BPD婴儿的膈肌功能效率似乎有所改善。我们推测这一发现可能反映了一种适应性过程，或者表明BPD婴儿为实现所需通气而增加了辅助肌的募集。产前和产后不良因素仅解释了膈肌效率差异的一小部分。
