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Effect of Intermittent Hypoxemia and Hyperoxemia during the Neonatal Period on Control of Breathing Function among
Nelson Claure1, Jose Tolosa2, Deepak Jain2
1Division of Neonatology, Departments of Pediatrics, Miller School of Medicine, Miami, FL; Biomedical Engineering, College of Engineering, University of Miami, Miami, FL.
Insights
Neonatal intermittent hypoxemia (IH) and hyperoxemia (HOX) in extremely preterm infants were linked to reduced peripheral chemoreception. This may explain ongoing respiratory issues in these vulnerable newborns.
Area of Science:
- Neonatal physiology
- Respiratory control
- Preterm infant care
Background:
- Extremely preterm infants experience significant fluctuations in blood oxygen levels, including intermittent hypoxemia (IH) and hyperoxemia (HOX).
- Chemoreception, the body's ability to sense chemical changes, is crucial for regulating breathing and is vital for preterm infant respiratory stability.
Purpose of the Study:
- To investigate the relationship between early-life IH and HOX and the development of peripheral and central chemoreception.
- To assess if these oxygen disturbances impact respiratory control mechanisms at near-term corrected age in extremely preterm infants.
Main Methods:
- An observational study involving 52 infants born between 23-28 weeks gestational age.
- Quantified daily IH frequency and time spent in HOX during the first 28 days of life.
- Assessed peripheral chemoreception via response to 100% O2 and central chemoreception via response to 4% CO2 at 36 weeks postmenstrual age.
Main Results:
- Increased IH and HOX were independently associated with a weaker ventilatory response to 100% oxygen.
- No significant association was found between IH/HOX and the ventilatory response to CO2.
Conclusions:
- Neonatal IH and HOX are linked to impaired peripheral chemoreception in extremely preterm infants.
- This impaired peripheral chemoreception may contribute to persistent respiratory instability in this population.
- Central chemoreception appears unaffected by early-life IH or HOX.
Objective:
To evaluate the association between intermittent hypoxemia (IH) and hyperoxemia (HOX) during the first 28 days with peripheral and central chemoreception at 36 weeks of postmenstrual age among infants born extremely preterm.
Study Design:
For this observational study, 52 infants born at 23-28 weeks of gestational age were enrolled. Mean daily IH frequency (arterial oxygen saturation <80% for ≥10 seconds) and percent of time in HOX (arterial oxygen saturation ≥98% while the fraction of inspired oxygen was >0.21) were calculated for the first 28 days of life. At 36 weeks of postmenstrual age, respiratory control tests assessed peripheral chemoreception by ventilatory response to 100% O2 for 30 seconds in which decreased ventilation caused by inhibition of peripheral chemoreceptors reflects their contribution to respiratory drive. Central chemoreception was evaluated by ventilatory response to 4% inspired CO2 for 10 minutes.
Results:
Multivariable generalized linear models showed increasing IH and HOX were independently associated with an attenuated ventilatory response to 100% O2 at 36 weeks of postmenstrual age. IH and HOX were not significantly associated with an attenuated ventilatory response to CO2.
Conclusions:
In these infants born extremely preterm, neonatal IH and HOX were independently associated with attenuated peripheral chemoreception at near-term corrected age. This may reflect reduced peripheral chemoreceptor oxygen sensitivity and may be in part responsible for persistence of respiratory instability in infants born preterm. Neonatal IH or HOX were not associated with reduced central chemoreception.
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