Cyda Reinaux

Motor development evaluated by Test of Infant Motor Performance: comparison between preterm and full-term infants.

OBJECTIVES To compare the motor development of preterm infants whose gestational age had been corrected to 38-40 weeks with full term newborns using the Test of Infant Motor Performance (TIMP). METHODS The cross-sectional study compared preterm infants (PT group), with a gestational age at birth of 28-33 weeks, at an equivalent age to full term newborns (FT group), who were assessed up to 48 hours after birth. The assessments were performed between December 2008 and April 2009 in a hospital nationally recognized for premature infant care in the city of Recife, PE, Brazil. The sample consisted of 92 infants, 46 in each group. The test was administered at age 38-40 weeks (or equivalent age in the PT group). RESULTS In the 46 preterm infants studied, 26.1% were classified as atypical, while in the FT group 100% were classified as typical (p<0.001). Moreover, there was a significant difference in average raw TIMP score between the two groups, with the PT group being lower (p<0.001). CONCLUSION According to TIMP performance, prematurity seems to be associated with impaired motor development.

Chest wall regional volumes in obese women

Excess body fat, particularly in the abdominal region, is responsible for respiratory system alterations. To study if and how both lung function and thoraco-abdominal volume variations during quiet breathing are altered in obese women and to determine if different obesity patterns in women have an influence on lung and chest wall function, 30 obese women (BMI ≥ 40 kg/m(2)) with both central and peripheral obesity were studied by spirometry and opto-electronic plethysmography during quiet breathing and compared with normoweight women. Compared to controls, obese were characterized by lung restriction and higher minute ventilation at rest. Pulmonary rib cage tidal volume variations were significantly lower and abdominal volume variations higher in obese women. No differences were found between central and peripheral obese women. In conclusion, in obese women, independently if obesity is central or peripheral, both lung function and thoraco-abdominal pattern during spontaneous breathing are strongly altered. The amount of fat in the abdominal compartment, and not the peripheral, alters the respiratory system.

Diagnostic accuracy of exhaled nitric oxide in exercise-induced bronchospasm: Systematic review

INTRODUCTION The gold-standard method for the diagnosis of exercise-induced bronchospasm (EIB) is an exercise test combined with spirometry. However, this test is expensive, time consuming and requires specialized equipment and trained personnel. Exhaled nitric oxide (eNO) is a fast, easy, noninvasive method for the diagnosis of EIB. The aim of the present study was to assess the accuracy of the measurement of eNO for the diagnosis of EIB through a systematic review of the literature. METHODS A search was carried out in the PubMed, Lilacs, SciELO and SCOPUS databases by two independent researchers. RESULTS Fifty-six papers were found. Following the application of the eligibility criteria to the title, abstract and text, six papers remained for analysis. There was a significant heterogeneity in sex (X(2)=56.44, p=0.000) and clinical spectrum (X(2)=504.00, p=0.000) between studies. In children between 3.8 and 7.8 years old a cutoff point >28ppb EIB can be ruled in and in children between 5 and 16 years old at a cutoff point <20EIB can be ruled out. For adults a cutoff point <7EIB can be ruled out and it can be ruled in with a cutoff point >12. Four papers reported negative predictive values above 88%. CONCLUSION The measurement of eNO seems to be effective for ruling in and ruling out EIB in some specific groups. Therefore, the measurement of eNO levels could be an important tool to safely avoid the need for an exercise test when the result is negative, reducing the individual and economic impact of this disease.

Influence of change in lateral decubitus on pulmonary aerosol deposition

BACKGROUND The lateral decubitus position leads to the greatest changes in regional pulmonary ventilation and is used in respiratory physical therapy routines. OBJECTIVES To evaluate the influence of the lateral decubitus position on the pulmonary deposition of inhaled radioaerosol particles in young people and report the effects of the decubitus position on routine therapy. METHODS Eight healthy male volunteers, mean age 23.6±2.5 years, were included in a randomized study in two phases. In the first phase, aerosol was inhaled for nine minutes in a randomly-selected lateral decubitus position and after an interval of 5 to 7 days, the second phase was conducted. Pulmonary scintigraphy was carried out by inhalation of 25 mCi of 99mTc-DTPA. Following inhalation, images were acquired with scintillation cameras and regions of interest (ROI) were investigated in the longitudinal and cross-sectional divisions of the lungs. Statistical analysis included a paired Students t-test with a significance level of p≤0.05. RESULTS Inhalation in the right lateral decubitus position presented higher counts (p≤0.04) in posterior ROI of the right lung than in the posterior ROI of the left lung. In the left lateral decubitus position, the count was higher in the left lung (p≤0.02) than in the posterior ROI of the right lung. CONCLUSIONS The deposition of aerosol particles during inhalation was position-dependent in the two phases of the study, which confirms the validity of technical and therapeutic resources based on the physiology of position-dependent ventilation and suggests that body positioning can be used to advantage in routine therapy.

Tidal volume measurements in infants: Opto-electronic plethysmography versus pneumotachograph

Tidal breathing measurements by Opto‐Electronic Plethysmography (OEP) has been reported for infants limited to protocols with two chest wall compartments. Standard protocol for the analysis of adults, with three compartments of chest wall, has been unavailable for analysis of infants. We aimed to study the agreement of simultaneous measurements of tidal volume by OEP (VT,OEP) and a heated pneumotachograph (PNT) (VT,PNT) performed during sleeping in 20 infants (gestational age 35.1 ± 4.6 weeks) at 3–4 months postconceptual age with a three compartment protocol. From PNT and OEP measurements, tidal volume corrected (VT,PNT) for ambient conditions were calculated with a total number of 200 breaths. The two methods were in good agreement with tidal volume mean difference of 0.02 ml and limit of agreement −4.11 to 4.08 ml (95%CI), no relationship was found between differences and means of OEP and PNT measurements. Pulmonary rib cage, abdominal rib cage and abdomen contributed by 12.4 ± 9.7%, 5.2 ± 5.1%, and 82.4 ± 11.4% to VT,OEP, respectively. The OEP experimental protocol based on 52 markers and a three‐compartment model of the chest wall could be used in spontaneously sleeping infants. Pediatr Pulmonol. 2016;51:850–857.

Influence of posture on the ventilatory pattern and the thoraco-abdominal kinematics of patients with chronic obstructive pulmonary disease (COPD)

Abstract Objective: Evaluate the influence of posture on ventilatory pattern, compartmental distribution of volume of chest wall and thoraco-abdominal kinematics of patients with severe chronic obstructive pulmonary disease (COPD). Design: Cross-sectional study. Methods: Twelve, male patients with severe COPD (Forced Expiratory Volume in the first second (FEV1) = 24.35 ± 4.52%, Forced Vital Capacity% (FVC%) = 60 ± 13.39% and relationship FEV1/FVC = 53.42 ± 14.47). The distribution of the volume of the ribcage [pulmonary rib cage (Rcp), abdominal ribcage (Rca) and abdomen (Ab)] during quiet breathing in a sitting position without back support (SWB), sitting with backrest (SB) and supine position (SUP) was determined using an opto-electronic plethysmograph. Results: The following differences were observed: a greater tidal volume in the SWB position when compared to the SB position (p = 0.01); greater expiratory time in the SUP position in relation to the SWB (p = 0.03) and SB (p = 0.01); and increased abdominal contribution to the tidal volume in the SUP position in relation to the SWB (p < 0.01) and SB (p < 0.001). No difference was found in the thoraco-abdominal synchrony among the positions. Conclusion: Sitting position without back support enhances the activation of respiratory muscles by increasing the tidal volume and supine position seems to favor lung deflation by increasing the expiratory time. It seems appropriate to adopt these positions to optimize the ventilation/perfusion relationship and physiotherapeutic intervention in different clinical conditions.

Exhaled nitric oxide as a diagnostic tool for wheezing in preschool children: A diagnostic accuracy study

BACKGROUND Airways inflammation may precede pulmonary dysfunction in wheezing individuals. The fraction of exhaled nitric oxide (FENO) has been described as a useful method for wheezing diagnosis in children, however, its application requires evidence. This study aimed to determine the accuracy of FENO in identifying wheezing in preschoolers. METHODS A cross-sectional study was carried out with children from 3 to 5 years old, from Brazilian day care centers and public schools. They were evaluated by FENO measurement through the single breath method, and by ATS-DLD-78-C questionnaire that is used as a gold standard to phenotype wheezing patterns. RESULTS The sample consisted of 243 non-wheezing children, 118 non-recurrent wheezing and 62 recurrent wheezing. The means of FENO and confidence intervals of 95%, were 5.4 (CI 95%, 5.2-5.6); 7.5 (CI 95%, 6.9-8.2) and 11.2 (CI 95%, 9.6-12.7), respectively. The sensitivity, specificity, positive and negative predictive FENO values in the 6 parts per billion (ppb) cut-off point that best diagnosed wheezing of non-wheezing children, were: 65.5%, 84.3%, 75.6% and 76.7%, respectively, with an area under the curve (AUC) = 0.77. At 10 ppb, the best cut-off points for differentiating recurrent wheezing of non-recurrent wheezing were: 56.4%, 81.3%, 61.4%, 78.0%, respectively, with an AUC = 0.69. The post-test probability for each FENO cut-off points was increased by 33% for wheezing and 20% for recurrent wheezing diagnosis when associated with clinical examination. CONCLUSION FENO can provide a reliable and accurate method to discriminate the presence and type of wheezing in preschoolers with 92% of acceptable in this study population.