, Volume 192, Issue 5, pp 765–773 | Cite as

Developing a Reference of Normal Lung Sounds in Healthy Peruvian Children

  • Laura E. Ellington
  • Dimitra Emmanouilidou
  • Mounya Elhilali
  • Robert H. Gilman
  • James M. Tielsch
  • Miguel A. Chavez
  • Julio Marin-Concha
  • Dante Figueroa
  • James West
  • William Checkley



Lung auscultation has long been a standard of care for the diagnosis of respiratory diseases. Recent advances in electronic auscultation and signal processing have yet to find clinical acceptance; however, computerized lung sound analysis may be ideal for pediatric populations in settings, where skilled healthcare providers are commonly unavailable. We described features of normal lung sounds in young children using a novel signal processing approach to lay a foundation for identifying pathologic respiratory sounds.


186 healthy children with normal pulmonary exams and without respiratory complaints were enrolled at a tertiary care hospital in Lima, Peru. Lung sounds were recorded at eight thoracic sites using a digital stethoscope. 151 (81 %) of the recordings were eligible for further analysis. Heavy-crying segments were automatically rejected and features extracted from spectral and temporal signal representations contributed to profiling of lung sounds.


Mean age, height, and weight among study participants were 2.2 years (SD 1.4), 84.7 cm (SD 13.2), and 12.0 kg (SD 3.6), respectively; and, 47 % were boys. We identified ten distinct spectral and spectro-temporal signal parameters and most demonstrated linear relationships with age, height, and weight, while no differences with genders were noted. Older children had a faster decaying spectrum than younger ones. Features like spectral peak width, lower-frequency Mel-frequency cepstral coefficients, and spectro-temporal modulations also showed variations with recording site.


Lung sound extracted features varied significantly with child characteristics and lung site. A comparison with adult studies revealed differences in the extracted features for children. While sound-reduction techniques will improve analysis, we offer a novel, reproducible tool for sound analysis in real-world environments.


Electronic auscultation Diagnosis Child Power spectrum Time–frequency analysis Filterbank Spectro-temporal analysis 



Additional support came from A.B. PRISMA, Instituto Nacional de Salud del Niño, and collaborators at JHU and Cincinnati Children’s Hospital. Thinklabs Medical (Centennial, CO) generously provided us with electronic stethoscopes at discount. Laura Ellington was supported by the Doris Duke Charitable Foundation Clinical Research Fellowship. Dimitra Emmanouilidou and Mounya Elhilali were partially supported by grants IIS-0846112 (NSF), 1R01AG036424-01 (NIH), N000141010278 (ONR), and N00014-12-1-0740 (ONR). William Checkley and James Tielsch were partially supported by the Bill and Melinda Gates Foundation (OPP1017682).

Conflict of interest

All authors in the study report no conflict of interest.

Supplementary material

408_2014_9608_MOESM1_ESM.docx (466 kb)
Supplementary material 1 (DOCX 465 kb)


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Laura E. Ellington
    • 1
  • Dimitra Emmanouilidou
    • 2
  • Mounya Elhilali
    • 2
  • Robert H. Gilman
    • 4
    • 5
  • James M. Tielsch
    • 3
  • Miguel A. Chavez
    • 4
  • Julio Marin-Concha
    • 4
  • Dante Figueroa
    • 5
    • 6
  • James West
    • 2
  • William Checkley
    • 1
    • 4
  1. 1.Division of Pulmonary and Critical Care, School of MedicineJohns Hopkins UniversityBaltimoreUSA
  2. 2.Department of Electrical and Computer EngineeringJohns Hopkins UniversityBaltimoreUSA
  3. 3.Department of Global Health, School of Public Health and Health ServicesGeorge Washington UniversityWashingtonUSA
  4. 4.Program in Global Disease Epidemiology and Control, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreUSA
  5. 5.Asociación Benéfica PRISMALimaPeru
  6. 6.Instituto Nacional de Salud del NiñoLimaPeru

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