Amplitude-integrated EEG recorded at 32 weeks postconceptional age. Correlation with MRI at term

The prevalence and characteristics of periodic breathing in preterm infants were measured by 24-hour impedance pneumograms in 66 preterm infants before discharge from the nursery. Four periodic breathing parameters (percentage of periodic breathing per quiet time, number of episodes of periodic breathing per 100 minutes of quiet time, mean duration of periodic breathing, and longest episode of periodic breathing) were compared to data available from healthy term infants and from term infants who subsequently died of sudden infant death syndrome (SIDS). Periodic breathing was found in all preterm infants studied and mean periodic breathing parameter values (12.0%, 8.6 episodes, 1.2 minutes, and 7.3 minutes, respectively) in our preterm population were substantially higher than values from healthy term infants and SIDS victims. Most periodic breathing parameters decreased significantly in infants studied at 39 to 41 weeks' postconceptional age compared with earlier postconceptional age groups. No relationship was found between central apneas of ≥15 seconds' duration and postconceptional age or any periodic breathing parameter. Periodic breathing is a common respiratory pattern in preterm infants that is usually not of pathologic significance. Associations between elevated levels of periodic breathing and respiratory dysfunction or SIDS should be made with caution.

Download Full-text

Transcutaneous Oxygen Tension During Nonnutritive Sucking in Preterm Infants

PEDIATRICS ◽

10.1542/peds.74.4.539 ◽

1984 ◽

Vol 74 (4) ◽

pp. 539-542

Author(s):

Roberto Paludetto ◽

Steven S. Robertson ◽

Maureen Hack ◽

Chandra R. Shivpuri ◽

Richard J. Martin

Keyword(s):

Heart Rate ◽

Respiratory Rate ◽

Preterm Infants ◽

Oxygen Tension ◽

Sleep State ◽

Transcutaneous Oxygen Tension ◽

Transcutaneous Oxygen ◽

Beneficial Effects ◽

Nonnutritive Sucking ◽

Postconceptional Age

The effects of nonnutritive sucking on transcutaneous oxygen tension, heart rate, and respiratory rate were studied sequentially in 14 sleeping preterm infants breathing room air. Transcutaneous oxygen tension increased during nonnutritive sucking in infants between 32 and 35 weeks postconceptional age, but not in those between 36 and 39 weeks. This response was not associated with a change in respiratory rate or sleep state, although heart rate tended to increase. These data offer further support for the beneficial effects of nonnutritive sucking in preterm infants.

Download Full-text

Delay in Caffeine Elimination in Breast-Fed Infants

PEDIATRICS ◽

10.1542/peds.79.2.264 ◽

1987 ◽

Vol 79 (2) ◽

pp. 264-268

Author(s):

Jean-Claude Le Guennec ◽

Bernard Billon

Keyword(s):

Half Life ◽

Blood Levels ◽

Daily Consumption ◽

Trough Blood ◽

Caffeine Citrate ◽

Nursing Mothers ◽

Postconceptional Age ◽

Breast Milk Jaundice ◽

Caffeine Metabolism ◽

Breast Fed

Because of a persistently elevated caffeine half-life observed in a breast-fed infant during caffeine maintenance therapy, we conducted this prospective iongitudinal study in two groups of infants (five exclusively breast-fed and 12 formula-fed). After 46 weeks' postconceptional age, all five breast-fed infants had a marked delay in caffeine elimination, compared with one infant in the formula-fed group. Four breast-fed infants had measurements of significantly longer caffeine half-lives compared with 12 formula-fed infants (76 ± 13 hours v 21 ± 28 hours and 54 ± 9 hours v 16 ± 13 hours at 47 to 50 weeks and 51 to 54 weeks postconceptional age, respwxricwly), as well as significantly higher trough blood levels (three- to five-fold) after 46 weeks' postconceptional age. The fifth breast-fed infant accumulated caffeine secondary to a steep increase in caffeine half-life from 102 hours at 44 weeks to 372 hours at 51 weeks. The elevated blood caffeine levels in breast-fed infants was not related to higher daily dosage of caffeine citrate (4.4 mg/kg compared with 8.3 mg/kg in the formula-fed group at 56 weeks' postconceptional age). Daily consumption of caffeine was low or nonexistent in four nursing mothers, and transfer of caffeine to the infant was considered to be trivial. The findings from this study suggest, as does breast milk jaundice due to inhibition of glycuronyl transferase, that some components of human milk (free fatty acid, lipase activity, or other factors) inhibit or repress the postnatal normal maturation process of caffeine metabolism by hepatic cytochrome P-450.

Download Full-text

Stabilizing immature breathing patterns of preterm infants using stochastic mechanosensory stimulation

Journal of Applied Physiology ◽

10.1152/japplphysiol.00058.2009 ◽

2009 ◽

Vol 107 (4) ◽

pp. 1017-1027 ◽

Cited By ~ 52

Author(s):

Elisabeth Bloch-Salisbury ◽

Premananda Indic ◽

Frank Bednarek ◽

David Paydarfar

Keyword(s):

Preterm Infants ◽

Respiratory Control ◽

Behavioral State ◽

Mean Square ◽

Breathing Patterns ◽

Nonlinear Properties ◽

Improved Stability ◽

Postconceptional Age ◽

The Stability ◽

Large Improvement

Breathing patterns in preterm infants consist of highly variable interbreath intervals (IBIs) that might originate from nonlinear properties of the respiratory oscillator and its input-output responses to peripheral and central signals. Here, we explore a property of nonlinear control, the potential for large improvement in the stability of breathing using low-level exogenous stochastic stimulation. Stimulation was administered to 10 preterm infants (postconceptional age: mean 33.3 wk, SD 1.7) using a mattress with embedded actuators that delivered small stochastic displacements (0.021 mm root mean square, 0.090 mm maximum, 30–60 Hz); this stimulus was subthreshold for causing arousal from sleep to wakefulness or other detectable changes in the behavioral state evaluated with polysomnography. We used a test-retest protocol with multiple 10-min intervals of stimulation, each paired with 10-min intervals of no stimulation. Stimulation induced an ∼50% reduction ( P = 0.003) in the variance of IBIs and an ∼50% reduction ( P = 0.002) in the incidence of IBIs > 5 s. The improved stability of eupneic breathing was associated with an ∼65% reduction ( P = 0.04) in the duration of O2 desaturation. Our findings suggest that nonlinear properties of the immature respiratory control system can be harnessed using afferent stimuli to stabilize eupneic breathing, thereby potentially reducing the incidence of apnea and hypoxia.

Download Full-text

Serum cystatin C during 30 postnatal days is dependent on the postconceptional age in neonates

Pediatric Nephrology ◽

10.1007/s00467-013-2429-4 ◽

2013 ◽

Vol 28 (7) ◽

pp. 1073-1078 ◽

Cited By ~ 21

Author(s):

Ji-Hyun Lee ◽

Won-Ho Hahn ◽

Jaeouk Ahn ◽

Ji-Young Chang ◽

Chong-Woo Bae

Keyword(s):

Cystatin C ◽

Serum Cystatin C ◽

Serum Cystatin ◽

Postconceptional Age

Download Full-text

Coregulation in Salivary Cortisol During Maternal Holding of Premature Infants

Biological Research For Nursing ◽

10.1177/1099800408327789 ◽

2008 ◽

Vol 10 (3) ◽

pp. 226-240 ◽

Cited By ~ 37

Author(s):

Madalynn Neu ◽

Mark L. Laudenslager ◽

JoAnn Robinson

Keyword(s):

Salivary Cortisol ◽

Neonatal Intensive Care ◽

Sound Level ◽

Holding Time ◽

Sound Levels ◽

Ambient Sound ◽

Antenatal Steroids ◽

Postconceptional Age ◽

Research Questions ◽

Cortisol Levels

Purpose: The purpose of this study was to examine coregulation between mothers and preterm infants in hypothalamic-pituitary-adrenocortical (HPA) system activity, as indicated by salivary cortisol levels, while mothers held their infants. The research questions were (a) does mother—infant coregulation in HPA activity occur during holding? and (b) if mother— infant coregulation in HPA activity exists during holding, do type of holding, antenatal steroids, sound level, and maternal touch influence this coregulation? Sample: The sample consisted of 20 mother— infant dyads with infants at a mean postconceptional age of 34.7 weeks (+0.7) and average postnatal age of 15 days (+9) at the time of cortisol sampling. Design: The design was exploratory using convenience sampling. Maternal and infant cortisol levels were obtained at Time 1 (baseline) and Time 2 (end of holding); at each time, the absolute differences in levels between mother and infant were determined. Coregulation was operationalized as less difference between maternal-infant cortisol levels immediately after holding (Time 2) as compared to before holding (Time 1). Results: The two variables with the highest correlation with the Time 1/Time 2 difference score included antenatal steroids and ambient sound level, which were entered into a linear regression equation as predictor variables. A coregulatory relationship in cortisol levels existed between mothers and infants during holding, which was moderated by sound levels. Nurses in the neonatal intensive care unit (NICU) can facilitate the mother—infant relationship, as reflected in coregulatory measures, by promoting a quiet environment, particularly around mothers who are holding their infants.

Download Full-text