Lung Function Tests in Neonates and Infants with Chronic Lung Disease: Forced Expiratory Maneuvers

• Published in: Pediatric pulmonology Vol. 41; no. 3; pp. 199 - 214
• Main Authors: Lum, Sooky, Hülskamp, Georg, Merkus, Peter, Baraldi, Eugenio, Hofhuis, Ward, Stocks, Janet
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.03.2006; Wiley-Liss
• Subjects: Airway Resistance - physiology; Biological and medical sciences; bronchopulmonary dysplasia; Bronchopulmonary Dysplasia - diagnosis; Bronchopulmonary Dysplasia - therapy; Female; Forced Expiratory Flow Rates; Forced Expiratory Volume; Humans; Infant; infant pulmonary function testing; Infant, Newborn; Infant, Premature; Lung Volume Measurements; Male; maximal expiratory flow-volume curves; Medical sciences; newborn; Oxygen Inhalation Therapy; Pneumology; premature; Respiration, Artificial - methods; respiratory distress syndrome; Respiratory Distress Syndrome, Newborn - diagnosis; Respiratory Distress Syndrome, Newborn - therapy; Respiratory Function Tests; Respiratory system : syndromes and miscellaneous diseases; Sensitivity and Specificity; Severity of Illness Index; Human; Premature; Lung disease; Pediatrics; infant pulmonary function testing; Respiratory disease; Chronic disease; Infant; Medical screening; respiratory distress syndrome; Newborn diseases; Lung function; Newborn; Volume; Bronchus disease; Bronchopulmonary dysplasia; Respiratory distress; Flow curve; maximal expiratory flow-volume curves
• ISSN: 8755-6863; 1099-0496
• DOI: 10.1002/ppul.20320

This fourth paper in a review series on the role of lung function testing in infants and young children with acute neonatal disorders and chronic lung disease of infancy (CLDI) addresses measurements of forced expiration using rapid thoraco‐abdominal compression (RTC) techniques and the forced deflation technique. Following orientation of the reader to the subject area, we focus our comments on the areas of inquiry proposed in the introductory paper to this series. The quality of the published literature is reviewed critically, and recommendations are provided to guide future investigation in this field. All studies on infants and young children with CLDI using forced expiratory or deflation maneuvers demonstrated that forced flows at low lung volume remain persistently low through the first 3 years of life. Measurement of maximal flow at functional residual capacity (V′maxFRC) is the most commonly used method for assessing airway function in infants, but is highly dependent on lung volume and airway tone. Recent studies suggested that the raised volume RTC technique, which assesses lung function over an extended volume range as in older children, may be a more sensitive means of discriminating changes in airway function in infants with respiratory disease. The forced deflation technique allows investigation of pulmonary function during the early development of CLDI in intubated subjects, but its invasive nature precludes its use in the routine setting. For all techniques, there is an urgent need to establish suitable reference data and evaluate within‐ and between‐occasion repeatability, prior to establishing the clinical usefulness of these techniques in assessing baseline airway function and/or response to interventions in subjects with CLDI. Pediatr Pulmonol. © 2005 Wiley‐Liss, Inc.