scholarly journals P168 Pre and postnatal factors associated with periodic breathing in preterm infants

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A76-A76
Author(s):  
A Yee ◽  
L Siriwardhana ◽  
G Nixon ◽  
F Wong ◽  
R Horne
Keyword(s):  
Preterm Infants ◽  
Respiratory Control ◽  
Periodic Breathing ◽  
Sleep Time ◽  
Respiratory Support ◽  
Chi Square ◽  
Factors Affecting ◽  
Specific Factors ◽  
Postnatal Factors

Abstract Introduction Immature cardio-respiratory control in preterm infants often manifests as periodic breathing (PB). A number of pre- and postnatal demographic and clinical factors, such as exposure to maternal smoking, respiratory support and medications may affect respiratory control. We aimed to identify specific factors affecting the frequency of PB in preterm infants before hospital discharge. Methods 32 healthy preterm infants (14M, 18F) born between 28–32 weeks of gestational age were studied for 2–3 hours with daytime polysomnography at 31–36 weeks (when they had been off respiratory support for ≥ 3 days). % sleep time spent in PB was calculated. Variables are reported as median (IQR) and were compared with Mann-Whitney U and Chi square tests, between infants who spent greater or less than the median time in PB. Results 29 infants (91%) exhibited at least one episode of PB. Median sleep time in PB was 9.6% (IQR 0.6, 15.6%). Infants with time in PB above the median spent fewer days on respiratory support (4.0 days (1.0, 7.5) vs 9.0 (6.5, 21.5) days, p=0.035), and were younger (post-menstrual age 33.8 (IQR 32.1, 34.5) vs 35.1 (IQR 32.4, 35.6) weeks, p= 0.039). Conclusions Of the large number of maternal and infant demographic and clinical variables examined, we found few associations with the time preterm infants spent in PB. Greater % time spent in PB was associated with earlier discontinuation of respiratory support, however larger studies are required to confirm these findings and to investigate if there are any long-term consequences.

scholarly journals Predictors of Developmental and Respiratory Outcomes Among Preterm Infants With Bronchopulmonary Dysplasia

2021 ◽  
Vol 9 ◽  
Author(s):  
Iris Morag ◽  
Efrat Barkai ◽  
Yaara Wazana ◽  
Arnon Elizur ◽  
Orly Levkovitz Stern ◽  
...  
Keyword(s):  
Environmental Factors ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Learning Algorithm ◽  
Medical Center ◽  
Factors Affecting ◽  
Lifestyle Questionnaire ◽  
Severe Group ◽  
Respiratory Outcomes ◽  
Postnatal Factors

Objectives: To examine the importance of perinatal and postnatal environmental factors on developmental and respiratory outcomes among preterm infants with bronchopulmonary dysplasia (BPD).Methods: Preterm infants (<32 weeks of gestation) born at a single tertiary medical center between 2012 and 2015 were included. Development was assessed at 12 months corrected age. Parents retrospectively completed a health and lifestyle questionnaire reviewing their child's health during the first 2 years of life. A linear regression model was applied to assess the effect of various perinatal and postnatal factors on development. A machine-learning algorithm was trained to assess factors affecting inhaler use.Results: Of 398 infants meeting the inclusion criteria, 208 qualified for the study: 152 (73.1%) with no BPD, 40 (19.2%) with mild BPD, and 16 (7.7%) with moderate-severe BPD. Those in the moderate-severe group were more likely to be male, have mothers who were less educated, and require longer ventilation periods and less time to regain birth weight. They were also more likely to have mothers with asthma/allergies and to have a parent who smoked. Those in the moderate-severe BPD group exhibited significantly lower developmental scores (85.2 ± 16.4) than the no-BPD group (99.3 ± 10.9) and the mild BPD group (97.8 ± 11.7, p < 0.008) as well as more frequent inhaler use (p = 0.0014) than those with no or mild BPD. In addition to perinatal factors, exposure to breast milk, income level and daycare attendance positively affected development. Exposure to cigarette smoke, allergies among family members and daycare attendance proved to be important factors in inhaler use frequency.Conclusions: Postnatal environmental factors are important in predicting and modifying early childhood outcomes among preterm infants.

scholarly journals Predicting Long-Term Respiratory Outcomes in Premature Infants: Is It Time to Move beyond Bronchopulmonary Dysplasia?

Children ◽  
2020 ◽  
Vol 7 (12) ◽  
pp. 283
Author(s):  
Deepak Jain ◽  
Alexander Feldman ◽  
Subhasri Sangam
Keyword(s):  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Respiratory Health ◽  
Perinatal Care ◽  
Factors Affecting ◽  
Modifiable Factors ◽  
Definition Of ◽  
Respiratory Outcomes ◽  
The Impact

Premature birth has been shown to be associated with adverse respiratory health in children and adults; children diagnosed with bronchopulmonary dysplasia (BPD) in infancy are at particularly high risk. Since its first description by Northway et al. about half a century ago, the definition of BPD has gone through several iterations reflecting the changes in the patient population, advancements in knowledge of lung development and injury, and improvements in perinatal care practices. One of the key benchmarks for optimally defining BPD has been the ability to predict long-term respiratory and health outcomes. This definition is needed by multiple stakeholders for hosts of reasons including: providing parents with some expectations for the future, to guide clinicians for developing longer term follow-up practices, to assist policy makers to allocate resources, and to support researchers involved in developing preventive or therapeutic strategies and designing studies with meaningful outcome measures. Long-term respiratory outcomes in preterm infants with BPD have shown variable results reflecting not only limitations of the current definition of BPD, but also potentially the impact of other prenatal, postnatal and childhood factors on the respiratory health. In this manuscript, we present an overview of the long-term respiratory outcomes in infants with BPD and discuss the role of other modifiable or non-modifiable factors affecting respiratory health in preterm infants. We will also discuss the limitations of using BPD as a predictor of respiratory morbidities and some of the recent advances in delineating the causes and severity of respiratory insufficiency in infants diagnosed with BPD.

scholarly journals Definitions of bronchopulmonary dysplasia and long-term outcomes of extremely preterm infants in Korean Neonatal Network

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ga Won Jeon ◽  
Minkyung Oh ◽  
Yun Sil Chang
Keyword(s):  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Respiratory Support ◽  
Long Term Outcomes ◽  
Respiratory Mortality ◽  
Increased Risk ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Original Definition

AbstractNew definitions for bronchopulmonary dysplasia (BPD) have recently been suggested, and an accurate diagnosis, including severity classification with proper definition, is crucial to identify high-risk infants for appropriate interventions. To determine whether recently suggested BPD definitions can better predict long-term outcomes of BPD in extremely preterm infants (EPIs) than the original BPD definition, BPD was classified with severity 1, 2, and 3 using three different definitions: definition A (original), National Institute of Child Health and Human Development (NICHD) definition in 2001; definition B, the modified NICHD 2016 definition (graded by the oxygen concentration and the respiratory support at 36 weeks’ postmenstrual age [PMA]); and definition C, the modified Jensen 2019 definition (graded by the respiratory support at 36 weeks’ PMA). We evaluated 1050 EPIs using a national cohort. Whereas EPIs with grade 2 or 3 BPD as per definition A did not show any increase in the risk, EPIs with BPD diagnosed by definition B and C showed significantly increased risk for poor outcomes, such as respiratory mortality and morbidities, neurodevelopmental delay, and growth restriction at 18–24 months of corrected age. The recently suggested definition and severity grading better reflects long-term childhood morbidities than the original definition in EPIs.

Measurement of the CO2 apneic threshold in newborn infants: possible relevance for periodic breathing and apnea

2005 ◽  
Vol 98 (4) ◽  
pp. 1171-1176 ◽  
Author(s):  
Akram Khan ◽  
Mansour Qurashi ◽  
Kim Kwiatkowski ◽  
Don Cates ◽  
Henrique Rigatto
Keyword(s):  
Control System ◽  
Confidence Interval ◽  
Preterm Infants ◽  
Newborn Infants ◽  
Respiratory Control ◽  
Periodic Breathing ◽  
Term Infants ◽  
Nonsignificant Increase ◽  
A Minor

We measured the Pco2 apneic threshold in preterm and term infants. We hypothesized that, compared with adult subjects, the Pco2 apneic threshold in neonates is very close to the eupneic Pco2, likely facilitating the appearance of periodic breathing and apnea. In contrast with adults, who need to be artificially hyperventilated to switch from regular to periodic breathing, neonates do this spontaneously. We therefore measured the apneic threshold as the average alveolar Pco2 (PaCO2) of the last three breaths of regular breathing preceding the first apnea of an epoch of periodic breathing. We also measured the PaCO2 of the first three breaths of regular breathing after the last apnea of the same periodic breathing epoch. In preterm infants, eupneic PaCO2 was 38.6 ± 1.4 Torr, the preperiodic PaCO2 apneic threshold was 37.3 ± 1.4 Torr, and the postperiodic PaCO2 was 37.2 ± 1.4 Torr. In term infants, the eupneic PaCO2 was 39.7 ± 1.1 Torr, the preperiodic PaCO2 apneic threshold was 38.7 ± 1.0 Torr, and the postperiodic value was 37.9 ± 1.2 Torr. This means that the PaCO2 apneic thresholds were 1.3 ± 0.1 and 1.0 ± 0.2 Torr below eupneic PaCO2 in preterm and term infants, respectively. The transition from eupneic PaCO2 to PaCO2 apneic threshold preceding periodic breathing was accompanied by a minor and nonsignificant increase in ventilation, primarily related to a slight increase in frequency. The findings suggest that neonates breathe very close to their Pco2 apneic threshold, the overall average eupneic Pco2 being only 1.15 ± 0.2 Torr (0.95–1.79, 95% confidence interval) above the apneic threshold. This value is much lower than that reported for adult subjects (3.5 ± 0.4 Torr). We speculate that this closeness of eupneic and apneic Pco2 thresholds confers great vulnerability to the respiratory control system in neonates, because minor oscillations in breathing may bring eupneic Pco2 below threshold, causing apnea.

INFORMATION SUPPORT FOR MAKING MANAGEMENT DECISIONS IN THE FIELD OF PREVENTION OF EYE DISEASES AT STUDENTS BASED ON MULTI-VARIANT SIMULATION AND FORECASTING

2020 ◽  
pp. 147-153
Author(s):  
Юлия Владимировна Татаркова ◽  
Татьяна Николаевна Петрова ◽  
Олег Валериевич Судаков ◽  
Александр Юрьевич Гончаров ◽  
Ольга Николаевна Крюкова
Keyword(s):  
Preventive Measures ◽  
Influential Factors ◽  
Eye Diseases ◽  
Information Support ◽  
Factor Space ◽  
Factors Affecting ◽  
Eye Fatigue ◽  
Modeling And Forecasting ◽  
Medical Examinations

В настоящей статье представлен обзор основных решений, доступных сегодня для формирования как краткосрочных, так и долгосрочных проекций заболеваемости болезней глаза и его придаточного аппарата в студенческой среде. С другой стороны, существует ряд проблем, связанных с многообразием факторов, влияющих на заболеваемость, статистической необоснованностью и противоречивостью имеющихся результатов анализа данных. Представлены результаты математического моделирования зависимости показателя заболеваемости от наиболее влиятельных факторов образовательной и социальной среды. Перечислены важнейшие направления разработки математических моделей распространения заболеваемости. С помощью разработанного программного комплекса проведена серия вычислительных экспериментов по оценке и прогнозированию заболеваемости обучающихся в вузах разного профиля. Показана эффективность применения методики многовариантного моделирования и прогнозирования, указаны их ограничения и возможности практического применения. По расположению обобщенной области благоприятного прогноза в факторном пространстве можно определить время воздействия неблагоприятных для зрения факторов, которое должно составлять не более 10 ... 11 часов в сутки, количество профилактических мероприятий должно составлять не менее 3 ... 4. При этом риск развития миопии составит не более 0,4, вероятность усталости глаз за компьютером составит не более 0,4, вероятность дискомфорта глаз на занятиях составит не более 0,15. Исходя из характера прогноза, определяется длительность диспансерного наблюдения, а также потребность профилактических мероприятий по устранению или ослаблению действия неблагоприятно влияющих социально-гигиенических и медико-биологических факторов конкретного больного. Использование прогностической матрицы в практическом здравоохранении позволяет существенно улучшить работу по профилактике офтальмологической заболеваемости и является одним из эффективных мероприятий диспансеризации студенческой молодежи, так как дает возможность выделить из числа обучающихся группу с высоким риском неблагоприятного исхода заболевания This article provides an overview of the main solutions available today for the formation of both short-term and long-term projections of the incidence of eye diseases and its adnexa in the student environment. On the other hand, there are a number of problems associated with a variety of factors affecting the incidence, statistical unreasonability and inconsistency of the available data analysis results. The results of mathematical modeling of the dependence of the incidence rate on the most influential factors of the educational and social environment are presented. The most important areas of developing mathematical models for the spread of morbidity are listed. With the help of the developed software package, a series of computational experiments was carried out to assess and predict the incidence of students in universities of various profiles. The effectiveness of the application of multivariate modeling and forecasting methods is shown, their limitations and practical application possibilities are indicated. By the location of the generalized region of favorable prognosis in the factor space, it is possible to determine the exposure time of factors unfavorable for vision, which should be no more than 10 ... 11 hours a day, the number of preventive measures should be at least 3 ... 4. At the same time, the risk of development myopia will be no more than 0.4, the probability of eye fatigue at the computer will be no more than 0.4, the likelihood of eye discomfort in the classroom will be no more than 0.15. Based on the nature of the forecast, the duration of the follow-up observation is determined, as well as the need for preventive measures to eliminate or weaken the action of adverse social, hygienic and biomedical factors of a particular patient. The use of the prognostic matrix in practical health care can significantly improve the work on the prevention of ophthalmic morbidity and is one of the effective medical examinations for students, since it makes it possible to distinguish among the students a group with a high risk of an unfavorable outcome of the disease

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