Take a Deep Breath and Move On
Better Lung Testing for Infants at Children's
Dr. Weiner’s patient Tess Wiggins, 17 months, undergoes iPFT at Children’s main campus in Oakland as her parents, Ted and Melissa, observe.
"It's time to change the way we think about lung function testing," says Daniel J. Weiner, MD. As medical director of the Pulmonary Function Laboratory at Children's Hospital of Pittsburgh of UPMC, Dr. Weiner believes that more objective lung function testing in infants can lead the way to better treatment.
"Our new Infant Pulmonary Function Testing [iPFT] allows us to look at flows over the entire range of lung volumes. Historically, testing for infants only examined flows from a smaller portion of lung volume, which was much less reproducible and sensitive," says Dr. Weiner. "This testing more accurately measures infants' flows, lung volume and lung stiffness. Importantly, objective response to medications like bronchodilators can be assessed."
The new iPFT system at Children's Hospital is one of about 40 in the country. It is designed to test children under 3 years of age, who have difficulty with traditional spirometry tests. "iPFT uses moderate sedation, and takes about 1-1/2 to 2 hours to complete," Dr. Weiner says. "Over that time, we inflate the lungs via a facemask, watching every breath the baby takes on a computer screen." iPFT employs an inflatable jacket, which is wrapped around the baby's chest. When air fills the jacket, it "hugs" the baby, simulating a forceful exhalation such as older children are coached to do. "It doesn't hurt the baby at all," Dr. Weiner says. "The infant is under sedation, and the parents can be in the room the whole time. We continually monitor heart rate, breathing rate, blood pressure, and oxygen and carbon dioxide levels."
Dr. Weiner recommends using iPFT to monitor the course of lung disease and adjust treatments. It can help doctors tell if they're missing an alternative diagnosis, and it can be useful for monitoring babies who have cystic fibrosis, even if they show no symptoms."iPFT is also used to study babies who have small lungs or unusual chest walls, or for babies who have been treated empirically for one diagnosis but haven't gotten better," he says.
"iPFT can help guide therapy and assess the risk of undergoing a procedure. If an infant needs a transplant, an operation or chemotherapy, iPFT may offer a more objective way to assess the risk of pulmonary complications."
To find out more about iPFT at Children's Hospital, contact Daniel J. Weiner, MD, at daniel.weiner@chp.edu.
