Periodic breathing and apnea in preterm infants
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1University of Alberta, Division of Paediatric Critical Care, Edmonton, Canada.
Insights
Periodic breathing in premature infants does not precede or trigger idiopathic apnea. This study found that significant apneic spells rarely occur near periodic breathing events.
Area of Science:
- Neonatal Physiology
- Respiratory Control in Infants
Background:
- Idiopathic apnea of prematurity is a common concern in preterm infants.
- Understanding the triggers and precursors of apneic events is crucial for infant care.
Purpose of the Study:
- To investigate the relationship between periodic breathing and idiopathic apnea of prematurity.
- To determine if periodic breathing precedes or contributes to significant apneic spells in preterm infants.
Main Methods:
- Respiratory impedance, heart rate, pulse oximetry, and end-tidal CO2 were monitored in 68 preterm infants (≤34 wk gestation).
- Apneic spells (>15s) associated with hypoxemia or bradycardia were identified via semiautomated analysis.
- Data were collected from untreated infants diagnosed with idiopathic apnea of prematurity.
Main Results:
- Only 1 of 1116 significant apneic spells occurred during periodic breathing.
- Fewer than 0.6% of significant apneic spells happened within 2 minutes of periodic breathing.
- Periodic breathing was not observed in the first 48 hours of life, suggesting peripheral chemoreceptor inactivity.
Conclusions:
- Periodic breathing is not a precursor to significant apnea in premature infants.
- The findings support the hypothesis of peripheral chemoreceptor immaturity in early neonatal life.
- Idiopathic apnea of prematurity appears to have triggers independent of periodic breathing.
Abstract:
The relationship between periodic breathing and idiopathic apnea of prematurity was investigated. We recorded respiratory impedance, heart rate, pulse oximetry and end-tidal CO2 from 68 untreated infants of less than or equal to 34 wk gestation with a diagnosis of idiopathic apnea of prematurity. Mean birth wt was 1476 g (SD 420) and mean gestational age was 29.9 wk (SD 2.6). Apneas of more than 15 s duration that were associated with hypoxemia or bradycardia were identified by semiautomated analysis of computerized records. A total of 1116 significant apneic spells were identified, only one of which occurred during an epoch of periodic breathing, five others occurred within 2 min of the end of an epoch of periodic breathing. Less than 0.6% of significant apneic spells occur within 2 min of periodic breathing. In all of the 12 infants that were monitored starting in the first 12 h of life, significant apneic spells were identified before 36 h of age and no precipitating factors were identified. Periodic breathing did not occur during the first 48 h of life, a finding that supports the concept that the peripheral chemoreceptor is inactive in the first 48 h of life. Periodic breathing in the premature infant is not a precursor to significant apnea.