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Determinants of lung volume in spontaneously breathing preterm infants
1Department of Pediatric Pulmonology, Hannover Medical School, Germany.
Insights
Apneic pauses significantly decrease functional residual capacity (FRC) in preterm infants. Sighs help restore FRC, highlighting strategies to improve oxygenation stability.
Area of Science:
- Neonatal Physiology
- Respiratory Medicine
Background:
- Preterm infants often experience breathing pattern irregularities, including apneic pauses and sighs.
- Functional residual capacity (FRC) is crucial for maintaining oxygenation, especially in vulnerable preterm neonates.
Purpose of the Study:
- To investigate the impact of apneic pauses, sighs, and breathing patterns on FRC in healthy preterm infants.
- To understand how these respiratory events influence oxygen saturation (SpO2) stability.
Main Methods:
- Measured FRC using a modified heliox/nitrogen washout technique in 48 preterm infants during unsedated sleep.
- Monitored breathing patterns, apneic pauses, sighs, and desaturations (SpO2 < 90%) preceding FRC measurements.
Main Results:
- Apneic pauses led to a significant decrease in FRC (20.0 ml/kg) compared to periods without pauses (24.0 ml/kg) or after sighs (26.0 ml/kg).
- Breathing pattern effects on FRC were mediated by apneic pauses.
- A faster fall in SpO2 during desaturation correlated inversely with FRC, indicating lower FRC exacerbates oxygen desaturation.
Conclusions:
- Apneic pauses cause a persistent reduction in FRC in preterm infants.
- Sighs play a role in restoring FRC.
- Strategies to increase FRC, like sighs or continuous positive airway pressure, are vital for stabilizing oxygenation in preterm infants.
Abstract:
To study the effects of apneic pauses, sighs, and breathing patterns on functional residual capacity (FRC), we measured FRC repeatedly in 48 healthy preterm infants (weight at study 2,042 +/- 316 g [mean +/- SD], postconceptional age 36.6 +/- 2.0 wk), during unsedated sleep using a modified heliox/nitrogen washout technique. Breathing movements and pulse oximeter saturation (SpO2) were recorded throughout and recordings analyzed for the presence of regular and nonregular breathing pattern, apneic pauses, sighs, and desaturations (SpO2 < 90%) during the last 2 min prior to each FRC measurement. FRC was lower during nonregular than during regular breathing pattern (23.3 +/- 7.2 ml/kg versus 26.9 +/- 7.8 ml/kg, p < 0.02); however, this apparent effect of breathing pattern disappeared after controlling the data for apneic pauses. Apneic pauses resulted in a significant decrease in FRC: mean FRC was 20.0 +/- 6.8 ml/kg if measured within 2 min of an apneic pause, 26.0 +/- 6.9 ml/kg if measured after a sigh (p < 0.001), and 24.0 +/- 7.7 ml/kg if there had been neither a sigh nor an apneic pause (p < 0.05). The interval between the apneic pause and the FRC measurement had no effect on FRC. There was an inverse correlation between FRC and the speed with which SpO2 fell during desaturation (r = -O.5, p < 0.03). Apneic pauses resulted in a persistent reduction in FRC in these preterm infants. Sighs appeared to restore FRC. The significant relationship between FRC and the speed of desaturation found in this study underscores the importance of endogenous or exogenous strategies that help to increase FRC, such as sighs or the application of continuous positive airway pressure, for the stability of oxygenation in preterm infants who have difficulty maintaining their oxygenation.