title: Ventilation/perfusion ratio and right to left shunt in healthy newborn infants.
abstract: Oxygenation impairment can be assessed non-invasively by determining the degree of right-to-left shunt and ventilation/perfusion (VA/Q) inequality. These indices have been used in sick newborn infants, but normative values have not been reported which are essential to determine the magnitude of the abnormality. We, therefore, aimed to measure the shunt and VA/Q in infants with no history of respiratory conditions and determine if there was any effect of supine or prone position and the reproducibility of the data. Data were analysed from infants who had undergone a hypoxic challenge and in a subset who had been assessed in the supine or prone position. Transcutaneous oxygen saturations (SpO2) were recorded at fractions of inspired oxygen (FIO2) of 0.21 and 0.15. Two independent raters used a computer software algorithm which analysed and fitted paired data for FIO2and SpO2and derived a curve which represented the best fit for each infant's data and calculated the shunt and VA/Q. The raters ability to interpret the SpO2value which corresponded to a given FIO2was compared. The downwards displacement of the FIO2versus SpO2curve was used to estimate the degree of right-to-left shunt and the rightwards shift of the curve was used to calculate the VA/Q ratio. The mean (SD) gestational age of the 145 infants was 39 (1.6) weeks, their birth weight was 2990 (578) gms and median (range) postnatal age at measurement 3 (1-8) days. The mean (SD) VA/Q ratio was 0.95 (0.21). None of the infants had a right-to-left shunt. No significant differences were found in VA/Q in the supine compared to the prone position. The intraclass correlation coefficient of VA/Q between two independent raters was 0.968 (95% CI 0.947-0.980), p < 0.001. Right-to-left shunt and VA/Q ratio in healthy newborn infants were similar in the prone compared to the supine position.
authors.affiliation: Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, 4th Floor Golden Jubilee Wing, Denmark Hill, SE5 9RS, London, UK. theodore.dassios@kcl.ac.uk.
authors.forename: Theodore
authors.initials: T
authors.lastname: Dassios
authors.affiliation: Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, 4th Floor Golden Jubilee Wing, Denmark Hill, SE5 9RS, London, UK.
authors.forename: Kamal
authors.initials: K
authors.lastname: Ali
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rossor
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.|National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Greenough
mesh_terms: D000465:Algorithms; D005260:Female; D005865:Gestational Age; D064368:Healthy Volunteers; D006321:Heart / Q000502:physiology*; D006801:Humans; D000860:Hypoxia / Q000473:pathology*; D007231:Infant, Newborn; D008168:Lung; D008991:Monitoring, Physiologic / Q000379:methods*; D010100:Oxygen / Q000737:chemistry*; D010477:Perfusion; D011247:Pregnancy; D015203:Reproducibility of Results; D014692:Ventilation-Perfusion Ratio
chemical_list: D010100:Oxygen
keywords: FIO2 versus SpO2 curve; Newborn infants; Right-to-left shunt; Ventilation perfusion ratio