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Published on: November 19, 2015
The late preterm infant and the control of breathing, sleep, and brainstem development: a review
Robert A Darnall1, Ronald L Ariagno, Hannah C Kinney
1Department of Physiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. robert.a.darnall@hitchcock.org
Insights
Late preterm infants (33-38 weeks gestation) show immature brainstem development, impacting breathing and feeding coordination. Further research is crucial for understanding and managing these infants.
Area of Science:
- Neonatal neuroscience
- Developmental pediatrics
- Respiratory physiology
Background:
- Late preterm infants (33-38 weeks gestation) exhibit less mature brainstem development compared to full-term infants.
- Significant, nonlinear developmental changes occur in the brainstem during late gestation.
- This immaturity affects upper airway control, lung volume regulation, laryngeal reflexes, breathing's chemical control, and sleep patterns.
Purpose of the Study:
- To investigate the neurodevelopmental aspects of late preterm infants.
- To address the paucity of clinical, physiological, neuroanatomic, and neurochemical data in this population.
- To improve the understanding and management strategies for late preterm infants.
Main Methods:
- The study focuses on analyzing existing data and highlighting research gaps.
- It emphasizes the need for clinical, physiological, neuroanatomic, and neurochemical investigations.
- Research will concentrate on brainstem maturation during the high-risk late preterm period.
Main Results:
- Ten percent of late preterm infants experience significant apnea of prematurity.
- These infants often present with delayed coordination of feeding and breathing.
- Brainstem immaturity is linked to impaired control of vital functions.
Conclusions:
- Late preterm infants require focused research to understand their unique developmental trajectory.
- Enhanced knowledge of brainstem maturation is essential for targeted clinical interventions.
- Developing specific management plans will improve outcomes for these vulnerable infants.
Abstract:
The brainstem development of infants born between 33 and 38 weeks' gestation is less mature than that of a full-term infant. During late gestation, there are dramatic and nonlinear developmental changes in the brainstem. This translates into immaturity of upper airway and lung volume control, laryngeal reflexes, chemical control of breathing, and sleep mechanisms. Ten percent of late preterm infants have significant apnea of prematurity and they frequently have delays in establishing coordination of feeding and breathing. Unfortunately, there is a paucity of clinical, physiologic, neuroanatomic, and neurochemical data in this specific group of infants. Research focused on this group of infants will not only further our understanding of brainstem maturation during this high risk period, but will help develop focused plans for their management.
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