Respiratory Development in Preterm Infants (original) (raw)
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Pediatric Research, 1994
Cardiorespiratory behavior during sleep has been investigated by comparing visually analyzed minutes of EEG sleep with the digitized values of these two physiologic variables for each corresponding minute. Continuous 3-h nighttime sleep studies on 37 full-term and preterm neonates at comparable postconceptional term ages were acquired under controlled conditions, using a 24-channel computerized monitoring system and an automated eventmarker program. Five thousand, two hundred ninety-four minutes were assigned an EEG state by traditional criteria. Eighteen preterm infants were compared with 19 full-term infants with respect to six cardiac and six respiratory measures: two nonspectral calculations (i.e. average per minute and variance of the means) and four spectral calculations of the cardiorespiratory signal (i.e. bandwidth, spectral edge, mean frequency, and ratio of harmonics). The relative capabilities of these measures to predict a sleep state change were investigated using discriminant analysis. A stepwise selection algorithm in discriminant analysis was used to identify the order of significance for the remaining variables. Eight cardiorespiratory measures were then submitted to multivariate analysis of variance to assess sleep state or preterm-full-term differences: mean frequency, bandwidth, average per minute, and ratio of harmonics for cardiac signals; and spectral edge, mean frequency, logarithm of variance, and ratio of harmonics for respiratory signals. Differences among the sleep states and between neonatal groups were highly significant (p < 0.0001). Interaction between sleep state and neonatal group was also significant (p < 0.034). Two variables differentiated preterm from full-term respiratory behavior: ratio (p I 0.001) and mean frequency (p 5 0.02). Three variables demonstrated differences between preterm and full-term cardiac behavior: average heart rate per minute (p I 0.001), ratio (p I 0.05), and bandwidth (p I 0.08). Notably, the lowest values for most spectral measures were noted during tract5 alternant quiet sleep compared with the three other segments of the ultradian sleep cycle. Our findings demonstrate sleep state-specific differences in cardiorespiratory behavior in neonates regardless of prematurity. Differences between preterm and full-term infants reflect altered functional development of the brain because of adaptation to prematurity, an extrauterine experience, or both and may contribute to a model of physiologic vulnerability of certain infants for sudden infant death syndrome. (Pediatr Res 36: 738-744, 1994) Abbreviations SIDS, sudden infant death syndrome EEG sleep organization, in general, is comparable for have been described between full-term and preterm inall newborns at postconceptional term ages regardless of fants in cardiorespiratory behavior, rapid eye moveprematurity at birth (1, 2). However, differences also ments, spectral content, and state organization (3-11). W e have reported differences between full-term and
Effects of non-invasive respiratory support on sleep in preterm infants evaluated by actigraphy
2021
Objective Few studies have evaluated sleep in preterm infants under non-invasive ventilatory support in neonatal intensive care units (NICU). The main objective of this study was to evaluate the influence of continuous positive airway pressure (CPAP) in the sleep of premature babies. Material and Methods Crossover study in a NICU. We selected preterm infants with gestational age between 28 and 37 weeks using nasal CPAP. Eighteen preterm were included. Patients were monitored with actigraphy and with the Neonatal Behavioral Assessment Scale (NBAS). Results Results showed a reduction in sleep effciency, total sleep time and total sleep period during the CPAP period when compared to the non-CPAP. NBAS demonstrated significantly greater time of deep sleep and light sleep in the period without CPAP. Conclusion Our data suggests that the use of CPAP, during the first week of life, in preterm neonates, is associated with transitory alterations of sleep organization.
When does prone sleeping improve cardiorespiratory status in preterm infants in the NICU?
Sleep, 2019
Study ObjectivesPreterm infants undergoing intensive care are often placed prone to improve respiratory function. Current clinical guidelines recommend preterm infants are slept supine from 32 weeks’ postmenstrual age, regardless of gestational age at birth. However, respiratory function is also related to gestational and chronological ages and is affected by sleep state. We aimed to identify the optimal timing for adopting the supine sleeping position in preterm infants, using a longitudinal design assessing the effects of sleep position and state on cardiorespiratory stability.MethodsTwenty-three extremely (24–28 weeks’ gestation) and 33 very preterm (29–34 weeks’ gestation) infants were studied weekly from birth until discharge, in both prone and supine positions, in quiet and active sleep determined by behavioral scoring. Bradycardia (heart rate ≤100 bpm), desaturation (oxygen saturation ≤80%), and apnea (pause in respiratory rate ≥10 s) episodes were analyzed.ResultsProne posit...
2014
Apnea, especially in preterm newborns (AoP) is one of the common problems encountered at neonatal units. Numerous factors are likely to play a role in the etiology of apnea. Recent data sugest a role for genetic predisposition of AoP. It seems, that physiological rather than pathological immaturity of the respiratory, or cardiorespiratory control, play a major part in the pathophysiology of AoP. Immaturity of the brainstem, cerebral cortex, receptors of the lungs and the airways as well as of the chemoreceptors contribute to the development of apnea in preterm newborns. Several neurotransmitters (GABA, adenosin, endorphins) and their maturational changes are including in pathogenesis of apnea, too. The instability of the upper airway in preterm infants, asynchrony of musculature of the upper airway and diaphragm, pathological changes in the upper airway and malformations of the central nervous system might also contribute to the occurrence and severity of AoP. In newborns, apnea occ...
Clinical associations of immature breathing in preterm infants: part 1—central apnea
Pediatric Research, 2016
Articles Clinical Investigation nature publishing group Background: Apnea of prematurity (AOP) is nearly universal among very preterm infants, but neither the apnea burden nor its clinical associations have been systematically studied in a large consecutive cohort. Methods: We analyzed continuous bedside monitor chest impedance and electrocardiographic waveforms and oxygen saturation data collected on all neonatal intensive care unit (NICU) patients <35 wk gestation from 2009 to 2014 (n = 1,211; >50 infant-years of data). Apneas, with bradycardia and desaturation (ABDs), defined as central apnea ≥10 s associated with both bradycardia <100 bpm and oxygen desaturation <80%, were identified using a validated automated algorithm. results: Number and duration of apnea events decreased with increasing gestational age (GA) and postmenstrual age (PMA). ABDs were more frequent in infants <31 wk GA at birth but were not more frequent in those with severe retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), or severe intraventricular hemorrhage (IVH) after accounting for GA. In the day before diagnosis of late-onset septicemia and necrotizing enterocolitis, ABD events were increased in some infants. Many infants continued to experience short ABD events in the week prior to discharge home. conclusion: Frequency of apnea events is a function of GA and PMA in infants born preterm, and increased apnea is associated with acute but not with chronic pathologic conditions.
Effect of maturation on oral breathing in sleeping premature infants
The Journal of Pediatrics, 1986
To evaluate the Influence of postnatal maturation on oral breathing, we measured nasal and oral ventilation during sleeP and the ventllatory response to nasal occluslon In 11 preterm infants. Studies were repeated at 31-32, 33-34, and 35-36 weeks postconceptlonal age. Premature Infants had rare episodes of spontaneous oronasal breathing durlng sleep. The frequency of oral breathing In response to nasal occlusion Increased wlth advanclng postconceptlonal age, from 8%-8% at 31-32 weeks to 26% __+ 18% at 33-34 weeks and 28% + 33% at 35,36 weeks. Oral breathing In preterm Infants, unlike that In term Infants, was characterlzed by Intermittent airway obstruction leadlng to a slgnlflcant decrease In respiratory rate, tidal volume, minute ventllatlon, and tcPo2 (P <0.005). When Inspiratory (R~) and expiratory (RE) reslstances during nasal and oral breathlng were compared, R~ increased from 41 _+ 30 to 234 _+ 228 (P <0.004) and Rm from 62 _+ 16 to 145 _+ 43 cm H20 9 L-I 9 sec (P <0.004). The ablllty of preterm Infants to use the oral route of breathing thus Increases with advancing postnatal maturation, but Its effectiveness may remaln limlted by hlgh oral airway resistance.
Clinical associations with immature breathing in preterm infants: part 2—periodic breathing
Pediatric Research, 2016
Articles Clinical Investigation nature publishing group Background: Periodic breathing (PB) is a normal immature breathing pattern in neonates that, if extreme, may be associated with pathologic conditions. Methods: We used our automated PB detection system to analyze all bedside monitor chest impedance data on all infants <35 wk' gestation in the University of Virginia Neonatal Intensive Care Unit from 2009-2014 (n = 1,211). Percent time spent in PB was calculated hourly (>50 infant-years' data). Extreme PB was identified as a 12-h period with PB >6 SDs above the mean for gestational age (GA) and postmenstrual age and >10% time in PB. results: PB increased with GA, with the highest amount in infants 30-33 wk' GA at about 2 wk' chronologic age. Extreme PB was identified in 76 infants and in 45% was temporally associated with clinical events including infection or necrotizing enterocolitis (NEC), immunizations, or caffeine discontinuation. In 8 out of 28 cases of septicemia and 10 out of 21 cases of NEC, there was a >2-fold increase in %PB over baseline on the day prior to diagnosis. conclusion: Infants <35 wk GA spend, on average, <6% of the time in PB. An acute increase in PB may reflect illness or physiological stressors or may occur without any apparent clinical event.