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The longitudinal effects of persistent periodic breathing on cerebral oxygenation in preterm infants
Pauline F F Decima1, Karinna L Fyfe2, Alexsandria Odoi3
1The Ritchie Centre, Monash Institute of Medical Research and Prince Henry's Institute, Monash University, Melbourne, VIC, Australia; Laboratoire PériTox, UMR-I 01 INERIS, Faculté de Médecine, Université de Picardie Jules Verne, Amiens, France.
Insights
Periodic breathing is common in preterm infants and persists for months. While often benign, it can cause significant drops in heart rate and brain oxygenation, especially in active sleep.
Area of Science:
- Neonatal Physiology
- Respiratory Control in Infants
- Neurodevelopmental Outcomes
Background:
- Periodic breathing is a frequent occurrence in preterm infants.
- It is generally considered a benign condition.
- Its long-term impact on infant physiology requires further investigation.
Purpose of the Study:
- To determine the incidence of periodic breathing in preterm infants up to six months post-term.
- To assess the effects of periodic breathing on heart rate (HR), oxygen saturation (SpO2), and brain tissue oxygenation index (TOI).
Main Methods:
- Polysomnography was used to record HR, SpO2, and TOI in 24 preterm infants (27-36 weeks gestational age).
- Recordings were taken at 2-4 weeks, 2-3 months, and 5-6 months post-term corrected age, in both quiet and active sleep, and prone/supine positions.
- Periodic breathing was defined as ≥3 apneas lasting ≥3 seconds each.
Main Results:
- Periodic breathing was observed in most infants studied, with decreasing frequency over time.
- Significant decreases in HR and TOI were noted at 2-3 months compared to 2-4 weeks.
- No effect of gestational age on periodic breathing frequency or duration was found.
Conclusions:
- Persistent periodic breathing is common in preterm infants even without clinical respiratory issues.
- While not always associated with significant desaturations, some infants experienced reduced cerebral oxygenation, particularly during active sleep.
- The neurodevelopmental implications of these findings remain undetermined and necessitate further research.
Objectives:
Periodic breathing is common in preterm infants, but is thought to be benign. The aim of our study was to assess the incidence and impact of periodic breathing on heart rate (HR), oxygen saturation (SpO2), and brain tissue oxygenation index (TOI) over the first six months after term-equivalent age.
Study Design:
Twenty-four preterm infants (27-36 weeks gestational age) were studied with daytime polysomnography in quiet sleep (QS) and active sleep (AS) and in both the prone and supine positions at 2-4 weeks, 2-3 months, and 5-6 months post-term corrected age. HR, SpO2, and TOI (NIRO-200 spectrophotometer) were recorded. Periodic breathing episodes were defined as greater than or equal to three sequential apneas each lasting ≥3 s.
Results:
A total 164 individual episodes of periodic breathing were recorded in 19 infants at 2-4 weeks, 62 in 12 infants at 2-3 months, and 35 in 10 infants at 5-6 months. There was no effect of gestational age on periodic breathing frequency or duration. Falls in HR (-21.9 ± 2.7%) and TOI (-13.1 ± 1.5%) were significantly greater at 2-3 months of age compared to 2-4 weeks of age.
Conclusions:
The majority of preterm infants discharged home without clinical respiratory problems had persistent periodic breathing. Although in most infants periodic breathing was not associated with significant falls in SpO2 or TOI, several infants had significant desaturations and reduced cerebral oxygenation especially during AS. The clinical significance of this on neurodevelopmental outcome is unknown and warrants further investigations.
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