Thoracoabdominal Asynchrony Is Not Associated with Oxyhemoglobin Saturation in Recovering Premature Infants

Brennan, C.; Ulm, L.; Julian, S.; Hamvas, A.; Ferkol, T.; Hoffman, J.; Linneman, L.; Kemp, J.

Neonatology. 2016 Dec 26; 111(4):297-302


BACKGROUND: Recovering premature infants are at risk for hypoxemia and lack of synchrony between their rib cage and abdomen due to airflow obstruction and poor respiratory compliance. Thoracoabdominal asynchrony (TAA) is a useful marker of resistive and elastic lung properties. Whether TAA predicts oxygenation is unknown. OBJECTIVES: We investigated oxyhemoglobin saturation (SpO2%) and TAA (phase angle, phi) in preterm infants with/without high-humidity nasal cannula (HHNC). METHODS: A cross-sectional observational study was conducted in 92 infants at 32 weeks' postmenstrual age. We measured SpO2% with pulse oximetry and TAA with phi via respiratory inductance plethysmography in infants (mean gestational age: 26.4 + 1.3 weeks) who required room air (n = 18) or HHNC with/without supplemental oxygen (1-5 liters per minute, FiO2 0.21-0.33, n = 74). We calculated median SpO2% from 24.7 + 10.0 min of quiet sleep and median phi from up to 60 breaths. RESULTS: Infants breathing room air alone had marked TAA (phi = 83.6 + 32.9 degrees , range: 10.9-148.5) as did those receiving varying degrees of ventilatory and oxygen support via HHNC (range of group means, phi = 47.0-90.0 degrees ). Infants breathing room air had statically greater median SpO2% than those receiving support (96.3 + 0.6% vs. 91.3 + 0.6%; ANOVA p = 0.001). SpO2% was not associated with TAA in either group (r2 = 0.09). CONCLUSION: Recovering premature infants exhibited TAA regardless of need for ventilatory support and supplemental oxygen. TAA was not associated with SpO2% in either group. Maintenance of SpO2% does not require correction of TAA.

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