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Site of upper airway obstruction in infants following an acute life-threatening event
1Department of Child Health, University Hospital, Nottingham, England.
Insights
Premature infants may experience life-threatening breathing events due to upper airway obstruction at the larynx. This study investigated laryngeal closure during apnea and periodic breathing in these infants.
Area of Science:
- Pediatric Pulmonology
- Neonatology
- Sleep Medicine
Background:
- Infants born prematurely are at higher risk for respiratory complications.
- Obstructive and mixed apnea can lead to life-threatening events in infants.
- The precise mechanisms of upper airway obstruction in this population require further elucidation.
Purpose of the Study:
- To investigate the site and nature of upper airway obstruction during cardiorespiratory events in infants born prematurely.
- To explore the potential role of laryngeal reflexes in these obstructive events.
Main Methods:
- Screening of 25 patients following an acute life-threatening event.
- Simultaneous cardiorespiratory monitoring and fiberoptic laryngoscopy.
- Identification of upper airway obstruction during obstructive and mixed apnea episodes.
Main Results:
- Laryngeal level obstruction was observed in 3 prematurely born infants.
- Observed obstruction involved closure of arytenoid masses and aryepiglottic folds over the vocal cords.
- Similar laryngeal closure was noted during periodic breathing in 4 infants.
Conclusions:
- Laryngeal obstruction is a potential cause of breathing events in some prematurely born infants.
- Periodic breathing may be associated with laryngeal closure.
- Laryngeal reflexes may play a role in the pathophysiology of these events.
Abstract:
Twenty-five patients were screened following an acute life-threatening event for the presence of obstructive and mixed apnea. Simultaneous cardiorespiratory monitoring with fiberoptic laryngoscopy was performed to identify the site of upper airway obstruction during these episodes. In 3 of these subjects, who had been born prematurely, obstruction was observed at the laryngeal level, with the arytenoid masses and aryepiglottic folds closing over across the vocal cords. Such closure was also observed during periodic breathing, which was found to be prominent in 4 of the infants studied. The possible role of laryngeal reflexes as a mechanism for these events is discussed.