Forced Oscillometry in Infants With Bronchopulmonary Dysplasia

Study Overview
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Brief Summary
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The purpose of this study is to use forced oscillometry technique (FOT) to measure pulmonary mechanics and function in in term infants and premature infants with bronchopulmonary dysplasia (BPD)

Detailed Description
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Pulmonary function testing has been the standard of care to diagnose and evaluate response to therapy in various respiratory diseases in adults and children. There are several equipment and techniques that are FDA approved for these purposes. However, there are currently no lung function tests that are practically feasible, clinically meaningful and widely used in infants. The forced oscillation technique (FOT) is a non-invasive method that had been used to measure respiratory mechanics. FOT employs small amplitude pressure oscillations superimposed on the normal breathing and therefore has the advantage over conventional lung function techniques that it does not require the performance of respiratory maneuvers. To date, the use of this technique is FDA approved in adults and children but remains largely experimental in infants and newborns. THORASYS has recently developed a new respiratory function test device aimed specifically at newborn and infants (0 - 2 years age group) called tremoflo N-100 (Neo). This new device measures lung function in only a few minutes while the newborn or infant is sleeping normally. It uses an adapted version of the Airwave Oscillometry (AOS) to calculate the impedance of the lungs and quantify airway obstruction. Diuretics and bronchodilators are two on the most commonly used medications to ameliorate the symptoms of BPD. The benefits of these therapies have not been shown to prevent the development of BPD in a randomized control trial (RCT). More recently, there have been some evidence from pharmacogenetic studies that the variability in bronchodilator responsiveness in patients with asthma, (and possibly BPD) may lie on the gene encoding the B2-adrenergic receptor (ADRB2) as well as within the associated G-protein receptor pathway, the nitric oxide biosynthetic pathway and other novel loci identified in recent genome-wide studies. This part of the study will be hypothesis generating to try to understand the variability in bronchodilator response in infants with BPD. Normative data will be established in term neonates.

Official Title
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Forced Oscillometry in Infants With Bronchopulmonary Dysplasia

Conditions
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Infant, Premature, Diseases, Bronchopulmonary Dysplasia, Respiratory Distress Syndrome

Intervention / Treatment
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* Device: Non-invasive forced airway oscillometry


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Preterm Cohort: Premature infants with BPD who are in room air based on the (per NICHD definition) Premature infants with BPD who are receiving low flow O2 support and able to maintain normal spO2 in Room air for brief period ( up to 3 minutes) Term Cohort without pulmonary disease Infants >36 weeks gestational age without pulmonary disease Infants < 4 weeks of age Exclusion Criteria: Infants with BPD requiring invasive or non-invasive positive pressure ventilation Infants with BPD who have associated genetic diagnosis or major congenital anomalies.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Single<br>Non-invasive forced airway oscillometry. Normative data will be established form term neonates without pulmonary disease | Device: Non-invasive forced airway oscillometry<br>* This non-invasive device will measure pulmonary mechanics in spontaneously breathing premature infants and term infants without pulmonary disease. Infant will be in supine position and breathing regularly. A cushioned mask will be placed on the infant's face, covering the nose and mouth. Measurements typically take less than 20 seconds and no more than 3 repetitions will be done at each time point.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Forced oscillation technique measurements | Baseline FOT measurements in premature infants with BPD and term infants without pulmonary disease. | FOT measurement prior to bronchodilator therapy | 
| Post-bronchodilator forced oscillation technique measurements (in subjects already receiving this therapy) | FOT measurements in premature infants with BPD following bronchodilator therapy. | FOT measurement 30 to 60minutes following bronchodilator therapy |