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Cardiorespiratory patterns in infants presenting with apparent life-threatening episodes
D P Southall1, R E Janczynski, J R Alexander
1Department of Paediatrics, National Heart and Lung Institute, Brompton Hospital, London, UK.
Insights
Infants experiencing apparent life-threatening events (ALE) often exhibit abnormal breathing patterns, including more apnoeic pauses and periodic breathing. These findings suggest cardiorespiratory dysregulation in infants with ALE.
Area of Science:
- Pediatrics
- Neonatology
- Cardiorespiratory Physiology
Background:
- Apparent life-threatening events (ALE) are a significant concern in infant care.
- Understanding the underlying physiological mechanisms of ALE is crucial for diagnosis and management.
Purpose of the Study:
- To investigate the cardiorespiratory patterns in infants with apparent life-threatening events (ALE).
- To compare breathing patterns and heart rates of infants with ALE to age-matched controls.
Main Methods:
- 24-hour electrocardiogram (ECG) and abdominal breathing movement recordings were analyzed for 77 infants with ALE and 157 controls.
- Detailed analysis of heart rate, respiratory rate, and breathing patterns was performed.
- Clinical outcomes and neurodevelopmental status were followed up.
Main Results:
- Infants with ALE demonstrated significantly higher numbers of apnoeic pauses (p < 0.001).
- Patients with ALE exhibited larger quantities of periodic breathing (p < 0.01).
- Lower respiratory rates during regular breathing were observed in the ALE group (p < 0.01).
- Neurodevelopmental problems were noted in 5 infants with ALE, including one case of non-accidental injury.
Conclusions:
- Infants experiencing ALE show distinct cardiorespiratory dysregulation compared to healthy controls.
- Abnormalities in breathing patterns, including apnea and periodic breathing, are characteristic of ALE.
- These findings underscore the importance of thorough cardiorespiratory monitoring in infants presenting with ALE.
Abstract:
A total of 305 infants presenting with apparent life-threatening events (ALE) were referred by their paediatricians and underwent 24-hour tape recordings of electrocardiogram and abdominal breathing movements (from a pressure capsule transducer). Seventy-seven of these infants, all full-term (greater than or equal to 37 weeks of gestation), were randomly selected, followed up for clinical outcome, and their recordings subjected to a detailed analysis of heart and respiratory rates and breathing patterns. Recordings on 157 age-matched, full-term controls were similarly analysed for comparison purposes. One of the 77 patients suffering from ALE had a pre-existing neurodevelopmental problem, and 4 more cases showed this at follow-up, including 1 case whose ALE was subsequently diagnosed as originating from non-accidental injury. Compared with controls and as a group, the patients suffering from ALE showed higher numbers of apnoeic pauses (p less than 0.001), larger quantities of periodic breathing (p less than 0.01) and lower respiratory rates during regular breathing (p less than 0.01).