• Telford Yeung, Nada Mohsen, Mohab Ghanem, Jenna Ibrahim, Jyotsna Shah, Dilkash Kajal, Prakesh S Shah, and Adel Mohamed.
• Department of Pediatrics, University Health Network, University of Toronto; Department of Pediatrics, Mount Sinai Hospital, Toronto; Department of Pediatrics, Windsor Regional Hospital Metropolitan campus, Windsor, ON, Canada.
• Chest. 2023 Feb 1; 163 (2): 324331324-331.

BackgroundDiaphragmatic atrophy associated with mechanical ventilation is reported in pediatric and adult patients, but a similar association has not been described in preterm infants with bronchopulmonary dysplasia (BPD).Research QuestionDoes BPD impact the diaphragm thickness (DT) and diaphragm excursion (DE) in infants born before 32 weeks' gestation compared with healthy late preterm or term infants?Study Design And MethodsIn this prospective observational case-control study, DT at end of expiration (DTexp), DT at end of inspiration (DTins), DT fraction (DTF), and DE (DE) were assessed using bedside ultrasound. Two groups were compared: infants with BPD (patients) and healthy, postmenstrual age-matched infants (control participants). To account for variations in body size between groups, diaphragmatic measurements were expressed as a ratio of body surface area (BSA). Statistical analyses were conducted using SAS software version 9.4 (SAS Institute, Inc.).ResultsWe enrolled 111 infants, including 56 preterm infants with BPD (mean ± SD study age, 37.7 ± 1.7 weeks) and 55 healthy control participants (mean ± SD study age, 38.1 ± 1.5 weeks). DTexp and DTexp to BSA ratio were significantly lower in the BPD group compared with the healthy control group (mean ± SD, 1.3 ± 0.4 mm vs 1.5 ± 0.4 mm [P = .01] and 7.1 ± 1.4 mm/m2 vs 7.8 ± 1.8 mm/m2 [P = .03]). DTF and DE were significantly higher in the BPD group vs the healthy control group (mean ± SD, 61.8 ± 26.0 vs 43.3 ± 19.7 [P < .01] and 6.0 ± 1.7 mm vs 4.4 ± 1.6 mm [P < .01], respectively).InterpretationIn infants with BPD, DTexp was significantly lower, whereas DTF and DE were significantly higher, compared with healthy, age-matched control participants. Future studies are required and should focus on describing the evolution of diaphragmatic dimensions in preterm infants with and without BPD.Trial RegistryClinicalTrials.gov; No.: NCT04941963; URL: www.Clinicaltrialsgov.Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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