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Ventilator-induced diaphragmatic dysfunction in extremely preterm infants: a pilot ultrasound study

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Abstract

To investigate the development of diaphragmatic dysfunction in ventilated extremely preterm infants (EPI) using diaphragm ultrasound (DU). EPI of less than 28 weeks’ gestational age who required mechanical ventilation within six hours of birth were included in this prospective, observational study. DU was performed once a day until four days of life. End-inspiratory and end-expiratory thicknesses of the diaphragm were measured, and the diaphragm thickening fraction was calculated. A total of 20 EPI were enrolled. After intubation, there was a progressive reduction in end-inspiratory thickness of the diaphragm from baseline to day 1 (P < 0.001), but not from day 1 to day 2 (P = 0.092), day 2 to day 3 (P = 1.0), or day 3 to day 4 (P = 1.0). There was also a significant reduction in the diaphragm thickening fraction from baseline to day 1 (P < 0.001), but not from day 1 to day 2 (P = 1.0), day 2 to day 3 (P = 1.0), or day 3 to day 4 (P = 1.0).

    Conclusions: This study provides the first evidence of diaphragmatic dysfunction in ventilated EPI. We demonstrated a rapid progression of ventilator-induced diaphragmatic dysfunction, with a significant reduction in diaphragm thickness and thickening fraction within 24 h of ventilation.

What is Known:

• Over-assistance of the ventilator suppresses respiratory effort and induces diaphragm unloading, resulting in diaphragm atrophy or dysfunction.

• Diaphragmatic dysfunction contributes to prolonged ventilator dependence and poor clinical outcomes.

What is New:

• Most extremely preterm infants develop diaphragmatic dysfunction after intubation within 24 hours.

• Diaphragm thickness and contraction ability measured by ultrasound would be important indicators of worsening breathing or respiratory outcomes.

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Fig. 1
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Data Availability

All data relevant to the study are included in the article or uploaded as supplementary information. Original data are available from the corresponding author upon reasonable request.

Abbreviations

CPAP:

Continuous positive airway pressure

DTF:

Diaphragm thickening fraction

DU:

Diaphragm ultrasound

EPI:

Extremely preterm infants

IQR:

Interquartile range

NICU:

Neonatal intensive care unit

Tde:

End-expiratory thickness of diaphragm

Tdi:

End-inspiratory thickness of diaphragm

VIDD:

Ventilator-induced diaphragmatic dysfunction

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Funding

This work was supported by Kawano Masanori Memorial Public Interest Incorporated Foundation for Promotion of Pediatrics (32-waka8).

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Authors and Affiliations

  1. Department of Neonatology, Ibaraki Children’s Hospital, Mito, Japan

    Yusuke Hoshino, Junichi Arai, Rena Miura-Fuchino, Yoshiya Yukitake, Daigo Kajikawa, Tae Kamakura & Ayako Hinata

  2. Diagnostic and Training Center for Pediatric Ultrasound, Ibaraki Children’s Hospital, Mito, Japan

    Yusuke Hoshino & Koji Hirono

  3. Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan

    Kazushi Maruo

Authors
  1. Yusuke Hoshino
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  2. Junichi Arai
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  3. Koji Hirono
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  4. Kazushi Maruo
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  5. Rena Miura-Fuchino
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  6. Yoshiya Yukitake
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  7. Daigo Kajikawa
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  8. Tae Kamakura
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  9. Ayako Hinata
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Contributions

Y.H. conceptualized and designed this study, contributed to data extraction, conducted the statistical analysis, and drafted the initial manuscript. J.A. supervised the study design. K.H. and R.M. contributed to data extraction. K.M. supervised the statistical analysis. Y.Y., D.K., T.K., and A.H. critically reviewed the manuscript for important intellectual content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yusuke Hoshino.

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Ethics approval

This study was approved by the institutional review board (2020IRB-28) at Ibaraki Children’s Hospital.

Consent to participate

Written informed consent was obtained from the parents of each patient.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Daniele De Luca.

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Supplementary file1 (DOCX 155 KB)

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Hoshino, Y., Arai, J., Hirono, K. et al. Ventilator-induced diaphragmatic dysfunction in extremely preterm infants: a pilot ultrasound study. Eur J Pediatr 182, 1555–1559 (2023). https://doi.org/10.1007/s00431-023-04846-z

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  • DOI: https://doi.org/10.1007/s00431-023-04846-z

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