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Response to tube breathing in preterm infants with apnea
C J Upton1, A D Milner, G M Stokes
1Department of Neonatal Medicine, City Hospital, Nottingham, United Kingdom.
Insights
Preterm infants
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Respiratory Physiology
Background:
- Preterm infants often exhibit immature respiratory control, leading to conditions like apnea.
- Understanding factors influencing respiratory adaptation is crucial for infant care.
Purpose of the Study:
- To investigate the impact of post-conceptional age and apnea frequency on respiratory control in preterm infants.
- To assess respiratory responses to tube breathing, a method simulating airway obstruction.
Main Methods:
- Studied 27 preterm infants (median birthweight 1.14 kg, gestational age 29 weeks) on 86 occasions.
- Utilized tube breathing with volumes equivalent to two anatomical dead spaces.
- Measured ventilation as a percentage above baseline, compared to an "expected" value.
Main Results:
- Ventilatory response to tube breathing significantly improved with increasing post-conceptional age (P < 0.0005).
- Responses ranged from 73% of expected ventilation at 26 weeks to 104% at 36 weeks.
- Postnatal age and apnea frequency did not independently affect respiratory control after accounting for post-conceptional age.
Conclusions:
- Respiratory control during tube breathing matures significantly with post-conceptional age in preterm infants.
- Despite initial poor adaptation in the most immature, infants with apnea do not show a major respiratory control deficit compared to those without.
- Findings suggest that post-conceptional age is the primary determinant of respiratory adaptation to airway challenges in this population.
Abstract:
In order to analyze the effects of maturity and apnea frequency on the respiratory control of preterm infants, we studied their responses to tube breathing using tubes equivalent to two anatomical dead spaces. Ventilation during tube breathing was expressed as a percentage above baseline and compared to an "expected" value calculated from the volume of the added tube. Twenty-seven preterm infants (median birthweight, 1.14 kg.; and gestational age, 29 weeks) were studied on 86 occasions. The percentage of "expected" ventilation increased with post-conceptional age (r = 0.48, slope = 3.12, P less than 0.0005), from a mean of 73% at 26 weeks up to 104% at 36 weeks. Using multiple regression analysis, neither postnatal age nor apnea frequency had any effect once allowance had been made for post-conceptional age. Although the respiratory adaptation of the most immature infants was poor, this study suggests that infants with apnea show no gross deficit in respiratory control, compared to those without apnea.