Clinical correlations and pulmonary function at 8 years of age after severe neonatal respiratory failure.

OBJECTIVES: The aim of this study was to determine the pulmonary sequelae of severe neonatal respiratory failure. STUDY DESIGN: 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. CONCLUSION: 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.

Obesity negatively impacts lung function in children and adolescents.

OBJECTIVES: To investigate the relationship between weight status (body mass index [BMI] percentile and BMI z-score) and lung volumes in healthy children and adolescents. HYPOTHESES: We hypothesized that: (a) there would be a significant inverse relationship between age- and sex-specific BMI distribution and functional residual capacity (FRC), and expiratory reserve volume (ERV), respectively; and (b) obese children would have significantly reduced FRC and ERV compared to their non-obese peers. METHODS: The medical records of all individuals who successfully performed pulmonary function testing between 2000 and 2007 at two university children's hospitals were reviewed. Participants were excluded if they had cardiopulmonary, neuromuscular, or chest wall disease. RESULTS: Of 1,469 record reviewed, 327 subjects met study criteria. Percent predicted ERV was lowest in the obese group (P < 0.001) while residual volume (RV) was lowest in the overweight and obese groups (P < 0.001). Underweight participants had a lower percent predicted forced vital capacity (FVC) (P = 0.027) and vital capacity (VC; P = 0.039). Obese participants had the lowest FEV1 /FVC (P < 0.001). A positive linear relationship existed between BMI z-score and percent predicted FVC, VC, and diffusing capacity of carbon monoxide (DLCO ). A negative linear relationship was found between BMI z-score and percent predicted FRC, ERV, RV, and absolute FEV1 /FVC. CONCLUSIONS: Our results show that increasing weight status in children and adolescents is associated with a general reduction in lung volume measurements, which may reflect impaired lung function, increased respiratory symptoms, and decreased functional status.