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Effect of maturation on oral breathing in sleeping premature infants
Insights
Preterm infants show increased oral breathing with maturation, but it
Area of Science:
- Neonatal physiology
- Respiratory control in infants
Background:
- Preterm infants often exhibit challenges with airway control during sleep.
- Understanding the development of oral breathing is crucial for neonatal care.
Purpose of the Study:
- To assess how postnatal maturation influences oral breathing patterns in preterm infants.
- To investigate the ventilatory response to nasal occlusion during sleep in relation to postconceptional age.
Main Methods:
- Measured nasal and oral ventilation during sleep in 11 preterm infants.
- Repeated measurements at 31-32, 33-34, and 35-36 weeks postconceptional age.
- Assessed the ventilatory response to nasal occlusion.
Main Results:
- Spontaneous oronasal breathing was rare in preterm infants during sleep.
- Oral breathing frequency increased with postconceptional age (8% to 28%).
- Oral breathing in preterm infants involved airway obstruction, decreasing respiratory rate, tidal volume, minute ventilation, and tcpo2.
Conclusions:
- The capacity for oral breathing improves with postnatal maturation in preterm infants.
- High oral airway resistance may limit the effectiveness of oral breathing in these infants.
- Further research is needed to address airway obstruction during oral breathing in preterm neonates.
Abstract:
To evaluate the influence of postnatal maturation on oral breathing, we measured nasal and oral ventilation during sleep and the ventilatory response to nasal occlusion in 11 preterm infants. Studies were repeated at 31-32, 33-34, and 35-36 weeks postconceptional age. Premature infants had rare episodes of spontaneous oronasal breathing during sleep. The frequency of oral breathing in response to nasal occlusion increased with advancing postconceptional age, from 8% +/- 8% at 31-32 weeks to 26% +/- 18% at 33-34 weeks and 28% +/- 33% at 35-36 weeks. Oral breathing in preterm infants, unlike that in term infants, was characterized by intermittent airway obstruction leading to a significant decrease in respiratory rate, tidal volume, minute ventilation, and tcpo2 (P less than 0.005). When inspiratory (Rl) and expiratory (RE) resistances during nasal and oral breathing were compared, Rl increased from 41 +/- 30 to 234 +/- 228 (P less than 0.004) and RE from 62 +/- 16 to 145 +/- 43 cm H2O X L-1 X sec (P less than 0.004). The ability of preterm infants to use the oral route of breathing thus increases with advancing postnatal maturation, but its effectiveness may remain limited by high oral airway resistance.