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Effect of neck rotation on the timing and pattern of infant tidal breathing
Insights
Neck rotation in infants did not significantly alter breathing patterns. However, some infants showed breathing changes at 90 degrees rotation, indicating potential susceptibility to airway obstruction.
Area of Science:
- Pediatric Pulmonology
- Infant Respiratory Physiology
Background:
- Neck flexion and extension impact upper airway patency.
- Limited data exists on the effects of neck rotation on infant respiration.
Purpose of the Study:
- To assess the influence of neck rotation on respiratory rate (RR), expiratory time (tE), and phase angle (phi) in healthy infants.
- To understand positional effects on infant breathing during sleep.
Main Methods:
- Seventeen healthy infants (1-4 months) were studied during quiet sleep.
- Neck rotation (0, 30, 60, 90 degrees) was measured using an inclinometer.
- Respiratory parameters (RR, tE, phi) were recorded via Respiratory Inductive Plethysmography.
Main Results:
- When comparing randomized positions, neck rotation did not significantly affect RR, tE, or phi.
- Initial measurements at 0 degrees differed significantly from randomized 0-degree measurements (0r), highlighting the importance of randomization.
- Two infants showed notable respiratory pattern changes (decreased RR, increased tE) at 90 degrees rotation.
Conclusions:
- Neck rotation generally does not significantly alter respiratory parameters in healthy infants during quiet sleep.
- Randomization is crucial for accurate baseline respiratory measurements in infants.
- Some infants may be susceptible to respiratory obstruction with significant neck rotation (90 degrees).
Abstract:
While neck flexion and extension are known to influence the patency of the upper airway, far less information is available regarding the effects of neck rotation. The effect of neck rotation on respiratory rate (RR), expiratory time (tE), and phase angle (phi) was assessed in 17 healthy infants aged between 1 and 4 months. An inclinometer was used to measure neck rotation and uncalibrated Respiratory inductive Plethysmography to measure the dependent variables while the infants were in natural, quiet sleep. Baseline measurements were made with the head positioned centrally (0 degree rotation); further measurement positions included 30 degrees, 60 degrees, 90 degrees rotation, and repeat measurement at 0 degree (0r degree) in randomized order. Mean RR, tE, and phi were determined for each infant in each position. Using the paired t-test, RR at 0 degree rotation was significantly higher than that at 0r degree rotation (mean difference, 5 bpm; 95% CI, 2.1, 8.1; P = 0.0023); mean tE at 0 degree rotation was significantly shorter than at 0r degree rotation (mean difference, -0.18s; 95% CI, -0.27, -0.07; P = 0.002); whereas phi remained similar (mean difference, 10 degrees; 95% CI, -2.2, 22.3; P = 0.10. These changes probably reflect the slowing of metabolism that occurs after the onset of quiet sleep, and they emphasize the importance of randomization. Measurements at 0r degree were randomized and hence were most likely to reflect the true basal condition of the infant with the head in a neutral position. Consequently, these data, rather than those collected at 0 degree at the onset of quiet sleep, were used for comparisons with all subsequent positional changes. When comparing the positions whose order was randomized, neck rotation did not significantly affect RR (P = 0.445), tE (P = 0.272), or phi (P = 0.169). However, two infants demonstrated marked changes in respiratory pattern with decreases in RR and increases in tE at 90 degrees rotation, suggesting that some infants may be susceptible to obstruction in this position.