A multicenter study demonstrates that impulse oscillometry, a non-invasive method for measuring lung function, is an effective tool for assessing respiratory health in extremely preterm infants.
RT’s Three Key Takeaways:
- Effective Lung Function Assessment: Impulse oscillometry (IOS) has been shown to be an effective, non-invasive tool for assessing lung function in extremely preterm infants, with high success rates in a multicenter study.
- High Acceptability Across Centers: The study achieved high technical acceptability rates for IOS testing across five Neonatal Research Network centers, demonstrating its potential for widespread use in clinical settings.
- Study Framework for Future Research: The study provides a framework for future research on lung health in preterm infants, highlighting key factors that influence the success of IOS testing, such as birth weight and ventilation history.
Infants born preterm remain vulnerable to numerous health complications, such as respiratory distress syndrome, chronic lung disease, and pulmonary dysfunction. Moreover, extremely low gestational age neonates (ELGANs), or babies born more than three months before the expected date of birth (< 29 weeks gestational age), have a higher likelihood of contracting bronchopulmonary dysplasia.
A careful assessment of lung function is, therefore, crucial for monitoring the respiratory outcomes in such premature infants.
Existing methods to evaluate lung function such as spirometry are limited by the need to perform forced exhalations. While impulse oscillometry (IOS), a non-invasive alternative, permits the measurement of lung respiratory mechanics without requiring forced expiration, there has been no report of an effective multicenter study design utilizing IOS to assess the lung function in ELGANs.
Study Demonstrates the Potential of IOS in ELGANs
A recent study, led by researchers from the Department of Pediatrics at Children’s Hospital of Philadelphia and published in Pediatric Investigation, sheds light on the suitability of IOS for testing lung function in a large multicenter ELGAN population.
“Despite the non-invasive nature of IOS, it has not been widely utilized to evaluate lung health in the ELGAN population. This motivated us to report our methods and success in implementing a multicenter protocol for obtaining research-quality oscillometry data in extremely preterm children,” says Katharine Tsukahara, MD, the lead author of the study, in a release.
In their study, the researchers recruited early school-age preterm children with a high risk of BPD from the Hydrocortisone for Bronchopulmonary Dysplasia Respiratory and Developmental Outcomes Study, along with preterm children with minimal BPD or no lung disease from the Transfusion of Prematures Early School Age Follow-Up study. Additionally, full-term children with healthy lungs were utilized to enable effective comparison across different study groups.
Multicenter Study Design and High Success Rates
A six-minute walk test and the International Study of Asthma and Allergies in Childhood questionnaire were employed across five Neonatal Research Network centers to evaluate respiratory function in the study participants. IOS was performed according to the Childhood Asthma Research and Education (CARE) Network procedures. To ensure the research quality of oscillometry data, the IOS reports were reviewed based on five quality criteria from the CARE Network for oscillometry studies in pediatric asthma.
Around 98% of the study participants attempted the oscillometry test. The technical acceptability of IOS across the three study groups was high and varied between 85%–90% of the attempted tests. Moreover, the acceptability across the five Neonatal Research Network centers remained high.
“Increased levels of ‘real-world’ success—the percentage of tests that met the research quality criteria in our study design—can be attributed to the rigorous in-person training for performing IOS, a careful review of data quality, and timely investigator meetings to identify and address challenges related to IOS testing”, says Tsukahara, explaining the high success rates of IOS in the study, in a release.
Factors Influencing Test Success and Future Research Implications
Additionally, the researchers investigated whether any clinical factor hindered the likelihood of producing acceptable oscillometry data in the study population. They found that lower birth weight, number of days requiring ventilation during neonatal intensive care unit course, and neuromotor comorbidities were associated with a higher rate of failure during IOS testing.
“Currently, clinical data regarding the trajectory of lung health in former preterm infants is limited. Our team’s study design has shown high levels of success and acceptability in generating research-quality IOS data in a population with high rates of prematurity-associated comorbidities. This study provides a possible framework for future research studies investigating lung function in former preterm patients,” Tsukahara says in a release.
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