{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T01:09:53Z","timestamp":1767834593794,"version":"3.49.0"},"reference-count":29,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,2,1]],"date-time":"2021-02-01T00:00:00Z","timestamp":1612137600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Monitoring work of breathing (WOB) is important to assess the pulmonary condition and adjust respiratory support in preterm infants. Conventional WOB measurement (esophageal pressure, tidal volume) is invasive and we hypothesized that monitoring diaphragm activity could be a noninvasive alternative to estimate WOB. The objective was to determine the correlation between conventional WOB measures and diaphragm activity, in preterm infants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>WOB and diaphragm activity, measured with transcutaneous electromyography (dEMG), were simultaneously recorded at different nasal continuous positive airway pressure (nCPAP) levels. During a 30\u2010s recording at each nCPAP level, dEMG parameters, inspiratory WOB (WOB<jats:sub>i<\/jats:sub>), and pressure time product (PTP<jats:sub>in<\/jats:sub>) were calculated per breath. The correlation coefficient between WOB\u2010 and dEMG\u2010measures was calculated using single breaths and after aggregating all breaths into deciles of incremental WOB<jats:sub>i<\/jats:sub>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifteen preterm infants were included (median gestational age, 28 weeks). Single\u2010breath analysis showed a poor median correlation of 0.27 (interquartile range [IQR], 0.03 to 0.33) and 0.08 (IQR, \u22120.03 to 0.28), respectively, for WOB<jats:sub>i<\/jats:sub> and PTP<jats:sub>in<\/jats:sub> with peak diaphragmatic activity (dEMG<jats:sub>peak<\/jats:sub>). A modest median correlation coefficient of 0.65 (IQR, 0.13 to 0.79) and 0.43 (IQR, \u22120.33 to 0.69) was found for, respectively, WOB<jats:sub>i<\/jats:sub> and PTP<jats:sub>in<\/jats:sub> with dEMG<jats:sub>peak<\/jats:sub> in the aggregated analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Diaphragm activity showed a modest correlation with WOB<jats:sub>i<\/jats:sub> and PTP<jats:sub>in<\/jats:sub> in an aggregated analysis. This finding warrants further studies in infants with more significant lung disease.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ppul.25284","type":"journal-article","created":{"date-parts":[[2021,2,3]],"date-time":"2021-02-03T05:12:16Z","timestamp":1612329136000},"page":"1593-1600","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Transcutaneous monitoring of diaphragm activity as a measure of work of breathing in preterm infants"],"prefix":"10.1002","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8468-2544","authenticated-orcid":false,"given":"Ruud W.","family":"van Leuteren","sequence":"first","affiliation":[{"name":"Department of Neonatology, Emma Children's Hospital, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands"},{"name":"Amsterdam Reproduction &amp; Development Research Institute Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5582-3472","authenticated-orcid":false,"given":"Cornelia G.","family":"de Waal","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Emma Children's Hospital, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerard J.","family":"Hutten","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Emma Children's Hospital, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands"},{"name":"Department of Neonatology, Emma Children's Hospital, Amsterdam UMC Vrije Universiteit Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frans H.","family":"de Jongh","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Emma Children's Hospital, Amsterdam UMC University of Amsterdam Amsterdam The 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