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Hypoxemia associated with feeding in the preterm infant and full-term neonate
Insights
Feeding hypoxemia in infants, characterized by low oxygen levels during feeding, is linked to central nervous system compromise. This condition in preterm infants and neonates typically resolves as they mature.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Neurodevelopmental Pediatrics
Background:
- Unexplained or persistent apnea is a concern in preterm and full-term neonates.
- Feeding-associated hypoxemia requires further investigation to understand its underlying causes and implications.
Purpose of the Study:
- To evaluate unexplained or persistent apnea in infants.
- To investigate the occurrence and characteristics of hypoxemia associated with feedings in neonates and preterm infants.
Main Methods:
- Polygraphic monitoring was conducted on over 150 preterm infants (≥36 weeks postconceptional age) and full-term neonates.
- A retrospective comparison group of infants without feeding hypoxemia was selected.
- Infants with feeding hypoxemia were assessed for central nervous system (CNS) compromise via end-tidal carbon dioxide pressure and computed tomography (CT) scans.
Main Results:
- Sixteen infants exhibited hypoxemia during feedings, preceded by irregular respiratory effort and followed by bradycardia.
- Infants with feeding hypoxemia showed elevated maximum end-tidal carbon dioxide pressure during sleep.
- Abnormal CT scans were more prevalent in the feeding hypoxemia group (7/11) compared to the control group (0/5).
- No association was found between feeding hypoxemia and sleep apnea or gastroesophageal reflux.
Conclusions:
- Feeding hypoxemia in infants is associated with evidence of CNS compromise.
- This condition appears to be related to neurological factors rather than sleep apnea or reflux.
- Feeding hypoxemia resolves with infant maturation.
Abstract:
Polygraphic monitoring studies were performed on more than 150 older preterm infants (postconceptional ages of 36 weeks or more) and full-term neonates to evaluate unexplained or persistent apnea. During polygraphic monitoring, 16 infants were observed to have hypoxemia associated with feedings. The feeding hypoxemia was accompanied by irregular respiratory effort and preceded any associated bradycardia. A comparison group of eight infants with similar gestational and postconceptional ages, but without feeding hypoxemia, was selected retrospectively from other infants referred for evaluation of persistent or unexplained apnea. The group with feeding hypoxemia showed evidence of CNS compromise as manifested by significant elevations of the maximum end-tidal carbon dioxide pressure during sleep and abnormal computed tomograms (7/11 v 0/5 in the comparison group). There was no relationship between feeding hypoxemia and sleep apnea or gastroesophageal reflux. Clinical follow-up showed that the feeding hypoxemia resolved with maturation.