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Published on: November 2, 2015
The relationship between intermittent hypoxemia events and neural outcomes in neonates
Juliann M Di Fiore1, Thomas M Raffay1
1Division of Neonatology, Rainbow Babies and Children's Hospital, Cleveland, OH, United States of America; Department of Pediatrics, Case Western Reserve University, Cleveland, OH, United States of America.
Insights
Intermittent hypoxemia in extremely preterm infants is common and linked to poor neurodevelopmental outcomes. Identifying specific patterns is crucial for targeted clinical care to reduce infant morbidity.
Area of Science:
- Neonatal medicine
- Neuroscience
- Pediatric critical care
Background:
- Extremely preterm infants (<28 weeks gestation) frequently experience intermittent hypoxemia (IH) in early postnatal life.
- IH exposure is associated with adverse neurodevelopmental outcomes, including cognitive delays, motor impairment, and intraventricular hemorrhage.
- Animal models demonstrate IH can trigger pathophysiological cascades, but not all patterns are harmful.
Purpose of the Study:
- To review patterns of IH in extremely preterm infants.
- To examine the link between IH and neonatal outcomes in human and animal studies.
- To explore potential mechanisms and clinical care modifications to mitigate IH-related morbidity.
Main Methods:
- Literature review of studies on intermittent hypoxemia in extremely preterm infants.
- Analysis of human and animal model data correlating IH exposure with neurodevelopmental and other outcomes.
- Examination of proposed mechanistic pathways and current therapeutic interventions.
Main Results:
- Frequent IH events are pervasive in extremely preterm infants.
- Increased IH frequency correlates with poor neural outcomes like language delays, motor deficits, and intraventricular hemorrhage.
- Some IH patterns may be neutral or even beneficial, while others are clearly deleterious.
Conclusions:
- Distinguishing between high-risk, neutral, and beneficial IH patterns is critical for clinical management.
- Targeted interventions for high-risk IH patterns can potentially reduce morbidity.
- Minimizing exposure to potentially harmful treatment modalities for low-risk IH patterns is warranted.
Abstract:
This brief review examines 1) patterns of intermittent hypoxemia in extremely preterm infants during early postnatal life, 2) the relationship between neonatal intermittent hypoxemia exposure and outcomes in both human and animal models, 3) potential mechanistic pathways, and 4) future alterations in clinical care that may reduce morbidity. Intermittent hypoxemia events are pervasive in extremely preterm infants (<28 weeks gestation at birth) during early postnatal life. An increased frequency of intermittent hypoxemia events has been associated with a range of poor neural outcomes including language and cognitive delays, motor impairment, retinopathy of prematurity, impaired control of breathing, and intraventricular hemorrhage. Neonatal rodent models have shown that exposure to short repetitive cycles of hypoxia induce a pathophysiological cascade. However, not all patterns of intermittent hypoxia are deleterious and some may even improve neurodevelopmental outcomes. Therapeutic interventions include supplemental oxygen, pressure support and pharmacologic drugs but prolonged hyperoxia and pressure exposure have been associated with cardiopulmonary morbidity. Therefore, it becomes imperative to distinguish high risk from neutral and/or even beneficial patterns of intermittent hypoxemia during early postnatal life. Identification of such patterns could improve clinical care with targeted interventions for high-risk patterns and minimal or no exposure to treatment modalities for low-risk patterns.
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