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Sensory stimulation for apnoea mitigation in preterm infants
Kathleen Lim1, Sophie J E Cramer2, Arjan B Te Pas2
1Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia.
Insights
Automated sensory stimulation systems could help manage apnoea (pauses in breathing) in preterm infants. Developing these systems, potentially using multiple senses, is crucial for better infant respiratory support.
Area of Science:
- Neonatal Medicine
- Developmental Neuroscience
- Respiratory Physiology
Background:
- Apnoea is common in preterm infants, leading to instability and potential neurodevelopmental issues.
- Current interventions for infant apnoea often require manual, reactive stimulation, which is insufficient.
- Existing therapies struggle to fully mitigate the burden of apnoeic events in hospitalized preterm infants.
Purpose of the Study:
- To review the effectiveness of various sensory stimulations in mitigating apnoea in preterm infants.
- To explore the potential of automated, closed-loop sensory stimulation systems for apnoea management.
- To identify the need for preventative and multi-modal stimulation approaches.
Main Methods:
- Systematic review of 31 studies on sensory stimulation for infant apnoea.
- Analysis of localized tactile, generalized kinesthetic, airway pressure, auditory, and olfactory stimulations.
- Evaluation of current automated stimulus: non-invasive intermittent positive pressure ventilation.
Main Results:
- All reviewed sensory stimulation methods demonstrated some positive effects on reducing apnoea frequency.
- Findings were not definitive, highlighting a lack of comparative studies.
- Non-invasive intermittent positive pressure ventilation is the sole automated clinical stimulus for persistent apnoea.
Conclusions:
- Automated closed-loop sensory stimulation systems are warranted for apnoea mitigation in preterm infants.
- Preventative and multi-modal sensory stimulation strategies should be developed.
- Further research is needed to establish definitive evidence and optimize stimulation protocols.
Abstract:
Apnoea, a pause in respiration, is ubiquitous in preterm infants and are often associated with physiological instability, which may lead to longer-term adverse neurodevelopmental consequences. Despite current therapies aimed at reducing the apnoea burden, preterm infants continue to exhibit apnoeic events throughout their hospital admission. Bedside staff are frequently required to manually intervene with different forms of stimuli, with the aim of re-establishing respiratory cadence and minimizing the physiological impact of each apnoeic event. Such a reactive approach makes apnoea and its associated adverse consequences inevitable and places a heavy reliance on human intervention. Different approaches to improving apnoea management in preterm infants have been investigated, including the use of various sensory stimuli. Despite studies reporting sensory stimuli of various forms to have potential in reducing apnoea frequency, non-invasive intermittent positive pressure ventilation is the only automated stimulus currently used in the clinical setting for infants with persistent apnoeic events. We find that the development of automated closed-looped sensory stimulation systems for apnoea mitigation in preterm infants receiving non-invasive respiratory support is warranted, including the possibility of stimulation being applied preventatively, and in a multi-modal form. IMPACT: This review examines the effects of various forms of sensory stimulation on apnoea mitigation in preterm infants, namely localized tactile, generalized kinesthetic, airway pressure, auditory, and olfactory stimulations. Amongst the 31 studies reviewed, each form of sensory stimulation showed some positive effects, although the findings were not definitive and comparative studies were lacking. We find that the development of automated closed-loop sensory stimulation systems for apnoea mitigation is warranted, including the possibility of stimulation being applied preventatively, and in a multi-modal form.
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