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Worsening of V'_maxFRC in Infants with Chronic Lung Disease in the First Year of Life

A More Favorable Outcome after High-Frequency Oscillation Ventilation

Department of Pediatrics, Divisions of Respiratory Medicine and Neonatology; Department for Experimental Medical Instrumentation; and Department of Biostatistics, Erasmus University Medical Center/Sophia Children's Hospital, Rotterdam; and Department of Pediatrics, Medical Center Alkmaar, Alkmaar, The Netherlands

Correspondence and requests for reprints should be addressed to Peter J. F. M. Merkus, M.D., Ph.D., Erasmus University Medical Center, Sophia Children's Hospital, Department of Pediatrics, Division of Respiratory Medicine, Room Sp-2469, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands. E-mail: merkus{at}alkg.azr.nl

Little is known about the development of maximal flow at functional residual capacity, a measure of airway patency, in infants with chronic lung disease (CLD). In a follow-up study, we evaluated V'_maxFRC in very low birth weight infants with CLD, treated with high-frequency oscillation ventilation (HFOV) or conventional mechanical ventilation. In 36 infants with CLD, V'_maxFRC was evaluated at 6 and/or 12 months corrected age, and the relationship between perinatal factors and lung function was studied. Mean (SD) birth weight and gestational age were 837 (152) g and 26.8 (1.7) weeks, respectively. At 6 and 12 months, mean V'_maxFRC was significantly below normal. Between 6 and 12 months, there was a mean (95% confidence interval) reduction in V'_maxFRC (Z score) of 0.5 (0.2–0.7) (p < 0.001). At 12 months, the mean V'_maxFRC (Z score) was higher for children initially treated with HFOV (n = 15), as compared with children treated with conventional mechanical ventilation (n = 16): mean (95% confidence interval) difference was 0.6 (0.2–1.0) (p = 0.008). We conclude that very low birth weight infants with CLD have decreased V'_maxFRC that worsen during the first year of life. Initial treatment with HFOV was associated with a more favorable outcome of V'_maxFRC at 12 months corrected age.

Key Words: neonatal chronic lung disease • prematurity • pulmonary function test • high-frequency oscillation ventilation

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