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Clinically unsuspected hypoxia during sleep and feeding in infants with bronchopulmonary dysplasia
M Garg1, S I Kurzner, D B Bautista
1Division of Neonatology and Pediatric Pulmonology, Childrens Hospital of Los Angeles, CA 90027.
Insights
Infants with bronchopulmonary dysplasia experience frequent, unsuspected oxygen desaturations during sleep, potentially causing sudden unexplained deaths. These events correlate with pulmonary function abnormalities in infants with BPD.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Respiratory Physiology
Background:
- Bronchopulmonary dysplasia (BPD) is associated with high rates of sudden unexplained postneonatal death.
- The underlying causes of these deaths in infants with BPD remain largely unknown.
- Hypothesis: Infants with BPD may have unsuspected arterial oxygen desaturation during sleep, linked to pulmonary function deficits.
Purpose of the Study:
- To investigate the occurrence and characteristics of oxygen desaturation during sleep in infants with BPD.
- To determine if desaturation events correlate with the severity of pulmonary function abnormalities.
- To compare oxygenation levels during sleep in infants with BPD, preterm infants without BPD, and term controls.
Main Methods:
- Studied 14 infants with BPD, 15 preterm infants with neonatal respiratory distress syndrome (NRDS) but no BPD, and 8 term controls.
- Continuous noninvasive monitoring of arterial oxygen saturation (SaO2) via pulse oximetry and transcutaneous oxygen tension during sleep, wakefulness, and feeding.
- Analysis of desaturation episodes (SaO2 < 90% and SaO2 < 80%) and correlation with airway resistance measured by body plethysmography.
Main Results:
- Infants with BPD and NRDS spent significantly more time with SaO2 < 90% compared to controls.
- Most desaturations occurred during feeding, followed by wakefulness and sleep states.
- Severe desaturations (SaO2 < 80%) were observed exclusively in infants with BPD and correlated with increased airway resistance.
Conclusions:
- Clinically unsuspected oxygen desaturation is frequent in preterm infants, with or without BPD.
- Profound hypoxemia during sleep may contribute to sudden unexplained deaths in infants with BPD.
- Pneumographic findings did not reliably predict oxygen desaturation events.
Abstract:
Infants with bronchopulmonary dysplasia have a high incidence of sudden, unexplained death in the postneonatal period; yet the cause of these deaths is unknown. It was hypothesized that infants with bronchopulmonary dysplasia, thought to be well oxygenated based on awake PaO2 values, would have clinically unsuspected arterial oxygen desaturation during sleep and that these would correlate with the severity of pulmonary function abnormalities. The infants studied were 14 with bronchopulmonary dysplasia, 15 who were preterm, had no bronchopulmonary dysplasia, but did have neonatal respiratory distress syndrome, and eight who were full term and used for control at 37 to 45 weeks postconception. Continuous noninvasive monitoring of oxygenation (arterial oxygen saturation [SaO2, pulse oximetry] and transcutaneous oxygen tension was performed during sleep, wakefulness, and feeding. Greater than 80% of each recording was free of artifact for SaO2. Preterm infants with bronchopulmonary dysplasia and respiratory distress syndrome spent greater time at SaO2 less than 90% than control infants. Most desaturations occurred during feeding and to a lesser extent during wakefulness, active sleep, and quiet sleep. Episodes of desaturation (SaO2 less than 90%) lasted 15 to 20 seconds and were not associated with apnea, bradycardia, cyanosis, or changes in transcutaneous PO2. Only infants with bronchopulmonary dysplasia showed severe desaturations (SaO2 less than 80%). Total desaturation in those infants correlated with airway resistance (body pressure plethysmography). Abnormal pneumographic findings did not predict abnormal desaturations. It was concluded that clinically unsuspected oxygen desaturation occurs frequently in preterm infants with and without bronchopulmonary dysplasia, and profound hypoxemia may be responsible for sudden unexplained deaths in these infants.