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The Longitudinal Effects of Persistent Apnea on Cerebral Oxygenation in Infants Born Preterm
Rosemary S C Horne1, Annie C H Fung2, Scott NcNeil1
1The Ritchie Center, Hudson Institute of Medical Research and Department of Pediatrics, Monash University, Melbourne, Australia.
Insights
Apneas are common in ex-preterm infants and significantly decrease heart rate and brain oxygenation. These effects worsen over the first six months, potentially impacting neurocognitive development.
Area of Science:
- Neonatal physiology
- Neurodevelopmental outcomes
- Cardiorespiratory monitoring
Background:
- Preterm infants are at higher risk for cardiorespiratory events post-discharge.
- Persistent apnea can affect vital signs and brain oxygenation in vulnerable infants.
- Understanding these impacts is crucial for predicting long-term neurodevelopmental trajectories.
Purpose of the Study:
- To determine the frequency and effects of apnea on heart rate (HR), oxygen saturation (SpO2), and brain tissue oxygenation index (TOI) in ex-preterm infants.
- To analyze changes in these parameters during the first six months post-term equivalent age.
- To investigate the relationship between apnea severity and gestational age, sleep state, or position.
Main Methods:
- Daytime polysomnography was conducted on 24 preterm infants (27-36 weeks gestational age) at 2-4 weeks, 2-3 months, and 5-6 months corrected age.
- Apneas lasting ≥3 seconds were analyzed for their maximal impact (nadir) on HR, SpO2, and TOI.
- Brain tissue oxygenation index was measured using NIRO-200 Hamamatsu.
Main Results:
- A total of 604 apneas were recorded across the three time points.
- Apnea duration, nadir HR, SpO2, and TOI were not significantly affected by gestational age at birth, sleep state, or sleep position.
- Decreases in HR and TOI were significantly more pronounced at 2-3 months and 5-6 months compared to 2-4 weeks post-term.
Conclusions:
- Frequent apneas in ex-preterm infants are associated with significant decreases in heart rate and cerebral oxygenation.
- These cardiorespiratory and oxygenation disturbances become more severe in the later months studied.
- Even brief apneas may contribute to the neurocognitive deficits observed in this population.
Objective:
To assess the incidence and impact of persistent apnea on heart rate (HR), oxygen saturation (SpO2), and brain tissue oxygenation index (TOI) over the first 6 months after term equivalent age in ex-preterm infants.
Study Design:
Twenty-four preterm infants born between 27 and 36 weeks of gestational age were studied with daytime polysomnography at 2-4 weeks, 2-3 months, and 5-6 months post-term corrected age. Apneas lasting ≥3 seconds were included and maximal percentage changes (nadir) in HR, SpO2, and tissue oxygenation index (TOI, NIRO-200 Hamamatsu) from baseline were analyzed.
Results:
A total of 253 apneas were recorded at 2-4 weeks, 203 at 2-3 months, and 148 at 5-6 months. There was no effect of gestational age at birth, sleep state, or sleep position on apnea duration, nadir HR, SpO2, or TOI. At 2-4 weeks, the nadirs in HR (-11.1 ± 1.2 bpm) and TOI (-4.4 ± 1.0%) were significantly less than at 2-3 months (HR: -13.5 ± 1.2 bpm, P < .05; TOI: -7.5 ± 1.1 %, P < .05) and at 5-6 months (HR: -13.2 ± 1.3 bpm, P < .01; TOI: -9.3 ± 1.2%, P < .01).
Conclusions:
In ex-preterm infants, apneas were frequent and associated with decreases in heart rate and cerebral oxygenation, which were more marked at 2-3 months and 5-6 months than at 2-4 weeks. Although events were short, they may contribute to the adverse neurocognitive outcomes that are common in ex-preterm children.
