Volumetric Capnography at 36 Weeks Postmenstrual Age and Bronchopulmonary Dysplasia in Very Preterm Infants

Roland P Neumann; Roland Gerull; Emanuela Zannin; Sotirios Fouzas; Sven M Schulzke

doi:10.1016/j.jpeds.2021.10.019

Volumetric Capnography at 36 Weeks Postmenstrual Age and Bronchopulmonary Dysplasia in Very Preterm Infants

J Pediatr. 2022 Feb:241:97-102.e2. doi: 10.1016/j.jpeds.2021.10.019. Epub 2021 Oct 24.

Authors

Roland P Neumann¹, Roland Gerull², Emanuela Zannin³, Sotirios Fouzas⁴, Sven M Schulzke⁵

Affiliations

¹ Department of Neonatology, University Children's Hospital Basel UKBB, University of Basel, Switzerland. Electronic address: roland.neumann@ukbb.ch.
² Department of Neonatology, University Children's Hospital Basel UKBB, University of Basel, Switzerland; Department of Neonatology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
³ Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milano, Italy.
⁴ Pediatric Respiratory Unit, University Hospital of Patras, Greece.
⁵ Department of Neonatology, University Children's Hospital Basel UKBB, University of Basel, Switzerland.

PMID: 34687691
DOI: 10.1016/j.jpeds.2021.10.019

Abstract

Objectives: To assess the feasibility of volumetric capnography in spontaneously breathing very preterm infants at 36 weeks postmenstrual age (PMA) and its association with clinical markers of lung disease including the duration of respiratory support and bronchopulmonary dysplasia (BPD).

Study design: We obtained mainstream volumetric capnography measurements in 143 very preterm infants at 36 weeks PMA. BPD was categorized into no, mild, moderate, and severe according to the 2001 National Heart, Lung and Blood Institute workshop report. Normalized capnographic slopes of phase II (S_nII) and phase III (S_nIII) were calculated. We assessed the effect of BPD, duration of respiratory support, and duration of supplemental oxygen on capnographic slopes.

Results: S_nIII was steeper in infants with moderate to severe BPD (76 ± 25/L) compared with mild (31 ± 20/L) or no BPD (26 ± 18/L) (P < .001). The association of S_nIII with moderate to severe BPD persisted after adjusting for birth weight z-score, respiratory rate, and airway dead space to tidal volume ratio. The diagnostic usefulness of S_nIII to discriminate between infants with and without moderate to severe BPD was high (area under the curve, 0.94; 95% CI, 0.89-0.99).

Conclusions: Volumetric capnography is feasible in spontaneously breathing preterm infants at 36 weeks PMA and reflects the degree of lung disease. This promising bedside lung function technique may offer an objective, continuous physiological outcome measure for assessment of BPD severity.

Trial registration: ClinicalTrials.gov: NCT02083562.

Keywords: bronchopulmonary dysplasia; capnography; infant; premature; respiratory function tests.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Bronchopulmonary Dysplasia / therapy*
Capnography*
Feasibility Studies
Female
Gestational Age
Humans
Infant, Newborn
Infant, Premature*
Infant, Very Low Birth Weight
Male
Point-of-Care Systems
Prospective Studies
Respiration, Artificial*
Severity of Illness Index*

Associated data

ClinicalTrials.gov/NCT02083562