Clinical correlations and pulmonary function at 8 years of age after severe neonatal respiratory failure.
OBJECTIVE
The aim of this study was to determine the pulmonary sequelae of severe neonatal respiratory failure.


METHODS
This was a multicenter, prospective study. Fifty-four survivors of neonatal respiratory failure (oxygenation indices >25 on two occasions), completed pulmonary function testing at 8 years of age. Thirty-one (57%) received extracorporeal membrane oxygenation (ECMO). Pulmonary outcome was based on spirometry and lung volume data. Pulmonary outcome for each diagnostic and treatment group is reported as mean and as percent predicted. Individually subjects were also classified based on spirometry, as either normal, obstructed (defined as forced expiratory volume (FEV(1)) in 1 sec:forced vital capacity (FVC) of <80 % predicted, or with reduced FVC (FCV of <80% predicted) with normal FEV(1)/FVC. Risk for adverse outcome was determined using univariate analysis.


RESULTS
Mean FVC, FEV(1) and FEV(25-75) were reduced in the total cohort. The reduction was greatest in the subgroup with CDH and the group treated with ECMO. Assessed individually, 54% of subjects had normal spirometry and lung volumes, 19% airflow obstruction, and 27% reduced FVC. Poorer pulmonary outcome was linked to ECMO, congenital diaphragmatic hernia (CDH), birth weight for gestational age <10th percentile, duration of hospitalization, or need for prolonged supplemental oxygen.


CONCLUSIONS
Neonates with severe respiratory failure due to CDH or needing ECMO and small for gestation are at increased risk of poorer pulmonary outcome and require close follow-up.
Majaesic
Carina M
CM
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. CarinaMajaesic@cha.ab.ca
Jones
Richard
R
Dinu
Irina A
IA
Montgomery
Mark D
MD
Sauve
Reginald S
RS
Robertson
Charlene M T
CM
D002648:Child; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D005541:Forced Expiratory Volume; D006548:Hernia, Diaphragmatic / Q000150:complications; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008168:Lung / Q000503:physiopathology*; D008297:Male; D015337:Multicenter Studies as Topic; D011446:Prospective Studies; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications*; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy; D012720:Severity of Illness Index; D013147:Spirometry; D014797:Vital Capacity