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Apnea and bradycardia during feeding in infants weighing greater than 2000 gm
Insights
Infant breathing problems, including central apnea, bradycardia, and oxygen drops, were observed during feeding and awake states. These issues were linked to uncoordinated sucking and breathing, impacting both full-term and premature newborns.
Area of Science:
- Neonatal physiology
- Pediatric respiratory medicine
Background:
- Infants nearing hospital discharge require assessment for potential breathing issues.
- Understanding feeding-related respiratory events is crucial for infant care.
Purpose of the Study:
- To identify and characterize breathing problems in infants before hospital discharge.
- To investigate the relationship between feeding, awake states, and respiratory events.
Main Methods:
- Observational study of ten infants (one full-term, nine premature) nearing discharge.
- Monitoring of central apnea, bradycardia, and transcutaneous oxygen levels during awake states, feeding, and sleep.
- Assessment of respiratory response to nasal occlusion.
Main Results:
- Central apnea with significant bradycardia and oxygen desaturation occurred during awake feeding (sucking/swallowing).
- These events were independent of feeding type (breast milk, formula, water) and esophageal pH.
- Infants demonstrated mouth breathing upon nasal occlusion while awake.
- Sleep-related apnea was less significant than awake events.
- Prolonged apneic events correlated with poorly coordinated sucking and breathing.
Conclusions:
- Uncoordinated sucking and breathing during awake states are a significant cause of apneic events in vulnerable infants.
- These findings highlight the need for careful respiratory monitoring during feeding in infants nearing discharge.
- Early identification and management of these breathing coordination issues are essential for safe infant discharge.
Abstract:
One full-term and nine premature infants who had been or were about to be discharged from the hospital were studied to identify any breathing problems. While awake and when sucking and swallowing, the infants had central apnea accompanied by significant bradycardia and significant drops in transcutaneous oxygen values. These events occurred whether infants were breast-fed or ingested human milk, formula, or water by bottle, and were not associated with falls in esophageal pH. While awake, after occlusion of both nostrils, the infants responded with mouth breathing. Sleep-related apneic episodes were also found but were less significant. The long apneic events were related to poorly coordinated sucking and breathing while awake.