Characterisation of the Hering-Breuer deflation reflex in the human neonate

Human infants have been observed making inspiratory efforts in response to chest compression. These may be a manifestation of the Hering-Breuer deflation reflex. We sought to stimulate the reflex in 33 term infants by rapidly reducing lung volume using an inflatable jacket. The effect of altering the timing, magnitude or rate of application of the lung deflation on the strength of the inspiratory response was investigated. Inspiratory effort was quantified by measuring (1) the rate of fall in oesophageal pressure on inspiration; and (2) the mean inspiratory flow (MIF) in response to lung deflation. Variables which significantly affected (1) and resulted in increased inspiratory effort were, in order of importance: larger rises in oesophageal pressure on chest compression (38%) (percentage of variance explained), greater reductions in lung volume below functional residual capacity (FRC) (26%), faster rates of lung deflation (19%) and slower respiratory rates (11%). Increased inspiratory efforts, as assessed by response (2), were generated by greater reductions in FRC (23%), larger rises in oesophageal pressure (11%) and faster rates of lung deflation (10%). Increasing deflation pressures eventually resulted in a plateau in both measures of inspiratory response. These results were consistent with the Hering-Breuer deflation reflex being activated which could have a role in protecting the FRC of the newborn infant.