Chest Radiograph Thoracic Areas and Lung Volumes in Infants Developing Bronchopulmonary Dysplasia

Objectives: To determine whether chest radiograph (CXR) thoracic areas and lung volumes differed between infants who did and did not develop BPD and according to the severity of BPD developed. Working Hypothesis: Infants developing BPD, particularly if moderate or severe, would have low CXR thoracic areas and lung volumes in the perinatal period. Study Design: Prospective study Patient-Subject Selection: 53 infants with a median gestational age of 28 (range 24-32) weeks. Methodology: CXR thoracic areas were calculated using a Picture Archiving and Communicating System (PACS) and lung volume assessed by measurement of functional residual capacity (FRC) in the first 72 hr after birth. BPD was diagnosed if the infants were oxygen dependent beyond 28 days, mild BPD in infants no longer oxygen dependent at 36 weeks post-menstrual age (PMA) and moderate/severe BPD in infants who required supplementary oxygen with or without respiratory support at 36 weeks PMA. Results: Thirty two infants developed BPD, 21 had moderate/severe BPD. The median CXR thoracic areas were higher (P < 0.0001) and FRCs were lower (P < 0.0001) in the BPD compared to no BPD infants. The median CXR thoracic areas of the moderate/severe group (P < 0.001) and the mild group (P < 0.05) were greater than that of the no BPD group and the median FRC of the moderate/severe BPD group was lower than the no BPD group (< 0.001) and the mild BPD group (P < 0.05). Conclusion: These results highlight that in the perinatal period infants developing BPD, particularly if mode rate/severe, have low functional lung volumes and may have gas trapping, which likely reflects ventilation inhomogeneity. Pediatr Pulmonol. 2009;44:80-85. (c) 2008 Wiley-Liss, Inc.