Chronic Pulmonary Disease in Neonates After Artificial Ventilation: Distribution of Ventilation and Pulmonary Interstitial Emphysema

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Abstract
To determine pulmonary function abnormalities in patients with neonatal bronchopulmonary dysplasia (BPD), we measured distribution of ventilation by nitrogen washout, minute and tidal volume, and arterial and alveolar gases in three groups of ten preterm infants with similar birth weights (mean = 1,340 g) and gestational ages (mean = 30.3 weeks). Infants in group A were never artificially ventilated, those in group B were ventilated but had no subsequent BPD, and those in group C were ventilated and developed BPD. Infants with BPD had severe maldistribution of ventilation (pulmonary clearance delay 223% versus 47% and 60% for groups A and B). They had decreased tidal volumes (5.3 ml versus 7.0 and 6.2 ml) and higher respiratory rates (60/min versus 47 and 48) but similar minute volumes. They also had increased Paco2 (53.6 torr versus 41.9 and 43.4 torr) and increased arterial-alveolar carbon dioxide gradients (6.8 torr versus 3.1 and 1.8 torr). There was no statistically significant difference between groups B and C for the time spent in fractional inspired oxygen > 0.40 and > 0.60, or the time ventilated or intubated, or the incidence of patent ductus arteriosus. Early pulmonary interstitial emphysema was much more common in the infants who subsequently developed BPD (eight of ten versus two of ten, P < .01).