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Updated: Aug 17, 2025
Investigation into Deep Breathing through Measurement of Ventilatory Parameters and Observation of Breathing Patterns
Published on: September 16, 2019
Periodic breathing in clinically stable very preterm infants
Alicia K Yee1, Leon S Siriwardhana1, Gillian M Nixon1,2
1Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
Insights
Most very preterm infants experience periodic breathing (PB) when stable and off respiratory support. Shorter respiratory support duration is linked to increased PB frequency and severity, potentially causing hypoxia.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Developmental Pediatrics
Background:
- Periodic breathing (PB) is common in preterm infants, but its frequency and severity in clinically stable infants off respiratory support require further investigation.
- Understanding factors influencing PB is crucial for managing cardiorespiratory stability in this vulnerable population.
Purpose of the Study:
- To determine the prevalence and severity of periodic breathing (PB) in clinically stable very preterm infants.
- To identify infant and maternal factors associated with increased PB duration and severity.
Main Methods:
- A sleep study was conducted on 38 infants (28-32 weeks gestational age) at 31-36 weeks postmenstrual age, after at least 3 days off noninvasive respiratory support.
- Measurements included percent total sleep time spent in PB (%TSTPB) and time with SpO2 <90%, <80%, and cerebral oxygenation <55% during PB.
- Infant and maternal characteristics were correlated with %TSTPB and hypoxia during PB.
Main Results:
- 92% of infants exhibited PB, with a median of 9.1% TSTPB.
- Significant hypoxia (SpO2 <80% or cerebral oxygenation <55%) occurred during PB in 37% of infants.
- Shorter duration of respiratory support, multigravida/multiparity, and maternal vitamin D deficiency were associated with higher %TSTPB.
Conclusions:
- The majority of stable, very preterm infants off respiratory support experience PB, with significant variability and potential for hypoxia.
- Reduced duration of respiratory support correlated with increased PB frequency and severity.
- Further research is needed to determine the impact of PB on neurocognitive outcomes.
Objective:
We aimed to investigate the frequency and severity of periodic breathing (PB) in clinically stable very preterm infants and identify infant and maternal factors associated with increased time spent and severity of PB in these infants.
Method:
Thirty-eight infants (28-32 weeks gestational age) who were ≥3 days off noninvasive respiratory support, were studied for 2-3 h with a daytime sleep study at 31-36 weeks postmenstrual age. Percent total sleep time spent in PB (%TSTPB) and time spent with SpO2 <90%, <80%, and cerebral oxygenation <55% during PB were calculated. Infant and maternal characteristics were correlated with %TSTPB and hypoxia during PB.
Results:
The majority of infants (92%) had at least one episode of PB and infants spent a median 9.1 [interquartile range: 1.2, 15.5] %TSTPB. 80%, 37%, and 37% of infants experienced SpO2 <90%, <80% and cerebral oxygenation <55%, respectively, during PB. Shorter duration of respiratory support, multigravida, multiparity, and maternal vitamin D deficiency were associated with higher %TSTPB. Multigravida, shorter duration on respiratory support, apnea of prematurity, and resuscitation at birth were associated with hypoxia during PB.
Conclusions:
The majority of very preterm infants exhibited PB when they were off respiratory support and considered clinically stable. The time spent in PB was very variable between infants and was associated with significant hypoxia in some infants. Fewer days spent on respiratory support was associated with both increased frequency and severity of PB. However, the potential contribution of PB to neurocognitive outcomes remains uncertain and warrants further investigations.
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