PERIODIC BREATHING AND APNEA IN PRETERM INFANTS. I. EVIDENCE FOR HYPOVENTILATION POSSIBLY DUE TO CENTRAL RESPIRATORY DEPRESSION

PEDIATRICS ◽  
1972 ◽  
Vol 50 (2) ◽  
pp. 202-218
Author(s):  
Henrique Rigatto ◽  
June P. Brady
Keyword(s):  
Preterm Infants ◽  
Periodic Breathing ◽  
Significant Shift ◽  
Peripheral Chemoreceptor ◽  
Co2 Response ◽  
Peripheral Chemoreceptors ◽  
Mean Values ◽  
Periodic Groups ◽  
Major Defect ◽  
Alveolar Capillary

We made 84 studies on 20 "healthy" preterm infants during the first 34 days of life to discover whether infants breathing periodically hypoventilate or hyperventilate and whether the major defect is at the central or peripheral chemoreceptors. Six infants breathed periodically (n = 26) and seven regularly (n = 27) at all times; seven infants breathed periodically (n = 15) or regularly (n = 16) in different studies. In these three groups (periodic, regular, and intermediate), we compared respiratory minute volume and frequency, heart rate, alveolar oxygen tension (PAO2) and alveolar carbon dioxide tension (PACO2) and PO2, PCO2 and pH of arterialized capillary blood, alveolar-capillary differences for PO2 and PCO2, peripheral chemoreceptor sensitivity and CO2 responses. We measured ventilation with a nosepiece and a screen flowmeter. The mean values for the intermediate and periodic groups were similar. There were major differences between the periodic and regular groups. The infants breathing periodically (1) hypoventilated, (2) showed a significant shift of the CO2 response curve to the right with a 22% decrease in slope, and (3) had an increased response to O2. However, the two groups had similar alveolar-capillary PO2 and PCO2 differences. These findings suggest that the major defect is not in the lungs or at the peripheral chemoreceptors but at the respiratory center (or central receptors).

Effects of CO2 on immediate ventilatory response to O2 in preterm infants

1976 ◽  
Vol 41 (5) ◽  
pp. 609-611 ◽  
Author(s):  
S. Albersheim ◽  
R. Boychuk ◽  
M. M. Seshia ◽  
D. Cates ◽  
H. Rigatto
Keyword(s):  
Preterm Infants ◽  
Ventilatory Response ◽  
Background Concentrations ◽  
Peripheral Chemoreceptor ◽  
Co2 Response ◽  
Peripheral Chemoreceptors ◽  
Paradoxical Response

We wanted to know wheter the paradoxical response to CO2 under various background concentrations of O2 in preterm infants was mediated at the peripheral chemoreceptors. In five preterm infants we estimated peripheral chemoreceptor activity using the immediate change in ventilation (first 30 s) when 15%, 40%, 60%, or 100% O2 was substituted for 21% O2. Potentiation between O2 and CO2 was assessed by comparing the response with and without 4% CO2. CO2 enhanced the immediate hyperventilation with hypoxia (P less than 0.005) and reduced the immediate hypoventilation with hyperoxia (P less than 0.025 for 40% O2). This effect of CO2 increased from .00% to 15% O2 (P lessthan 0.05). These findings suggest: 1) CO2 interacts with O2 at the peripheral chemoreceptor level, and 2) because this interaction is more pronouncedwith hypoxia, the flatter CO2 response we observed with hypoxia was probably not mediated through the peripheral chemoreceptors and is likely to be central in origin.

Chemoreceptor Reflexes in Preterm Infants: I. The Effect of Gestational and Postnatal Age on the Ventilatory Response to Inhalation of 100% and 15% Oxygen

PEDIATRICS ◽  
1975 ◽  
Vol 55 (5) ◽  
pp. 604-613
Author(s):  
Henrique Rigatto ◽  
June P. Brady ◽  
Rafael de la Torre Verduzco
Keyword(s):  
Heart Rate ◽  
Preterm Infant ◽  
Preterm Infants ◽  
Ventilatory Response ◽  
Periodic Breathing ◽  
Postnatal Life ◽  
Low Oxygen ◽  
Peripheral Chemoreceptor ◽  
Peripheral Chemoreceptors ◽  
Oxygen Breathing

We studied 16 "healthy" preterm infants (birthweight, 1,000 to 2,000 gm) 94 times during postnatal life to define the effect of gestational and postnatal age on the ventilatory response to 100% and 15% oxygen. They were given air, then 100% oxygen for two and five minutes respectively (No. = 63) or 21%, 15%, and then 21% oxygen for five minutes each (No. = 31). We measured respiratory minute and tidal volumes, frequency, heart rate, and alveolar Pco2 and Po2. We used the magnitude of the immediate change in ventilation during 100% and 15% oxygen breathing to test peripheral chemoreceptor function. The immediate decrease in ventilation with 100% oxygen and the immediate increase in ventilation with 15% oxygen were statistically similar at different gestational and postnatal ages. The late increase in ventilation (five minutes) with 100% oxygen was also similar at different ages. However, the late decrease in ventilation with 15% oxygen was not present at 18 days of age. These findings suggest that: (1) the peripheral chemoreceptors are active at least from 28 weeks of gestation and are probably not important in triggering periodic breathing or apnea in preterm infants; and (2) the preterm infant matures his response to hypoxia and is able to sustain hyperventilation with low oxygen by 18 days of age.

Effect of baseline oxygenation on the ventilatory response to inhaled 100% oxygen in preterm infants

1995 ◽  
Vol 79 (6) ◽  
pp. 2101-2105 ◽  
Author(s):  
A. Z. Haider ◽  
V. Rehan ◽  
S. Al-Saedi ◽  
R. Alvaro ◽  
K. Kwiatkowski ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Ventilatory Response ◽  
Recovery Period ◽  
Control Period ◽  
Periodic Breathing ◽  
Quiet Sleep ◽  
Peripheral Chemoreceptor ◽  
Lower Baseline ◽  
O2 Concentration ◽  
Flow Through

We tested the hypothesis that the immediate (< 1 min) ventilatory response to 100% O2 in preterm infants, a test of peripheral chemoreceptor activity characterized by a decrease in ventilation due to apnea, is more pronounced at lower baseline O2 concentrations. We studied 12 healthy preterm infants [birth weight 1,425 +/- 103 (SE) g; study weight 1,670 +/- 93 g; gestational age 30 +/- 1 wk; postnatal age 27 +/- 7 days] during quiet sleep. The infants inhaled 15, 21, 25, 30, 35, 40, and 45% O2 for 5 min in a randomized manner (control period), followed by 100% O2 for 2 min, and then the same initial O2 concentration again for 2 min (recovery period). A nose piece and a flow-through system were used to measure ventilation. The immediate decrease in ventilation with 100% O2 was 46% on 15% O2, 24% on 21% O2, 11% on 25% O2, 8% on 30% O2, 12% on 35% O2, and 8% on 40% O2; there was no decrease on 45% O2 (P < 0.01). The corresponding mean duration of apnea was 29 s during 15% O2, 18 s during 21% O2, 8 s during 25% O2, 9 s during 30 and 35% O2, and 3 s during 40% O2; only one infant developed a 5-s apnea during 45% O2 (P < 0.001). The findings suggest that 1) the ventilatory decrease in response to 100% O2 is dependent on the baseline oxygenation, being more pronounced the lower the baseline O2 concentration; and 2) this ventilatory decrease is entirely related to more prolonged apneas observed with lower baseline O2 concentrations. We speculate that the peripheral chemoreceptors, being so active in the small preterm infant with relatively low arterial PO2, are highly susceptible to changes in PO2, and this makes them prone to irregular or periodic breathing, especially during sleep.

Peripheral chemoreceptors in health and disease

2004 ◽  
Vol 96 (1) ◽  
pp. 359-366 ◽  
Author(s):  
Nanduri R. Prabhakar ◽  
Ying-Jie Peng
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Defense Mechanism ◽  
Experimental Models ◽  
Cellular Mechanisms ◽  
Peripheral Chemoreceptor ◽  
Peripheral Chemoreceptors ◽  
Oxygen Homeostasis ◽  
Arterial Blood ◽  
Carotid Bodies

Peripheral chemoreceptors (carotid and aortic bodies) detect changes in arterial blood oxygen and initiate reflexes that are important for maintaining homeostasis during hypoxemia. This mini-review summarizes the importance of peripheral chemoreceptor reflexes in various physiological and pathophysiological conditions. Carotid bodies are important for eliciting hypoxic ventilatory stimulation in humans and in experimental animals. In the absence of carotid bodies, compensatory upregulation of aortic bodies as well as other chemoreceptors contributes to the hypoxic ventilatory response. Peripheral chemoreceptors are critical for ventilatory acclimatization at high altitude. They also contribute in part to the exercise-induced hyperventilation, especially with submaximal and heavy exercise. During pregnancy, hypoxic ventilatory sensitivity increases, perhaps due to the actions of estrogen and progesterone on chemoreceptors. Augmented peripheral chemoreceptors have been implicated in early stages of recurrent apneas, congestive heart failure, and certain forms of hypertension. It is likely that chemoreceptors tend to maintain oxygen homeostasis and act as a defense mechanism to prevent the progression of the morbidity associated with these diseases. Experimental models of recurrent apneas, congestive heart failure, and hypertension offer excellent opportunities to unravel the cellular mechanisms associated with altered chemoreceptor function.

Optic Nerve Sheath Diameter in Preterm Infants: Suggested Values

Neonatology ◽  
2021 ◽  
Vol 118 (3) ◽  
pp. 297-300
Author(s):  
Molly Rayner ◽  
Tanya Holt ◽  
Sibasis Daspal ◽  
Prosanta Mondal ◽  
Leanne Langford ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Linear Regression ◽  
Preterm Infants ◽  
Gestational Age ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Mean Values ◽  
Nerve Sheath ◽  
Neurologic Sequelae ◽  
Highly Correlated

<b><i>Objective:</i></b> Timely detection of elevated intracranial pressure (ICP) in highrisk preterm infants may be critical to avoid permanent neurologic sequelae. Size of optic nerve sheath diameter (ONSD) is highly correlated with changes in ICP. Normal ultrasonographic ONSD values for preterm infants have been published. This study sought to compare these data with MRI measured OSND and to propose suggested ultrasonographic ONSD values. <b><i>Methods:</i></b> The ONSD in preterm MRIs were retrospectively measured and related to pre-existing ultrasonographic ONSD. Data were stratified for corrected gestational age. Simple linear regression between ONSD mean values and age was modeled for both eyes, and <i>R</i><sup>2</sup> was calculated. Suggested values for ultrasonographic ONSD were ascertained through linear regression and calculated prediction intervals. <b><i>Results:</i></b> ONSD measurements demonstrated <i>R</i><sup>2</sup> values of 0.95 (right ONSD MRI), 0.95 (left ONSD MRI), 0.96 (right ONSD ultrasound), and 0.93 (left ONSD ultrasound). Suggested ONSD values were incremental with corrected gestational age. <b><i>Conclusion:</i></b> ONSD measurements with MRI and ultrasound are similar. The proposed suggested ONSD values may be helpful in clinical situations where ICPs are suspected or known.

Periodic Breathing in Preterm Infants: Incidence and Characteristics

PEDIATRICS ◽  
1989 ◽  
Vol 84 (5) ◽  
pp. 785-792
Author(s):  
S. F. Glotzbach ◽  
R. B. Baldwin ◽  
N. E. Lederer ◽  
P. A. Tansey ◽  
R. L. Ariagno
Keyword(s):  
Preterm Infants ◽  
Age Groups ◽  
Periodic Breathing ◽  
Sudden Infant Death ◽  
Respiratory Pattern ◽  
Sudden Infant ◽  
Quiet Time ◽  
Term Infants ◽  
Respiratory Dysfunction ◽  
Postconceptional Age

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.

PERIODIC BREATHING AND APNEA IN PRETERM INFANTS. II. HYPOXIA AS A PRIMARY EVENT

PEDIATRICS ◽  
1972 ◽  
Vol 50 (2) ◽  
pp. 219-228
Author(s):  
Henrique Rigatto ◽  
June P. Brady
Keyword(s):  
Preterm Infants ◽  
Oxygen Tension ◽  
Minute Ventilation ◽  
Arterial Oxygen Tension ◽  
Blood Gases ◽  
Periodic Breathing ◽  
Capillary Blood ◽  
Arterial Oxygen ◽  
Primary Event ◽  
The Relationship

We studied nine healthy preterm infants during the first 35 days of life to define the relationship between periodic breathing, apnea, and hypoxia. For this purpose we compared ventilation/apnea (V/A), minute ventilation, and alveolar and capillary blood gases during periodic breathing induced by hypoxia and during spontancous periodic breathing in room air. We induced periodic breathing by giving the baby in sequence 21, 19, 17, and 15% O2 to breathe for 5 minutes each, and also by giving 21, 15, and 21% O2. We measured ventilation with a nosepiece and a screen flowmeter. With a decrease in arterial oxygen tension, preterm infants (1) hypoventilated, (2) breathed periodically more frequently, and (3) showed a decrease in V/A due to an increase in the apneic interval. In one baby this led to apnea lasting 30 seconds. These findings support our hypothesis that preterm infants breathing periodically hypoventilate and suggest that hypoxia may be a primary event leading to periodic breathing and apnea.

Reduction in Obstructive Breathing Events During Body Rocking: A Controlled Polygraphic Study in Preterm and Full-Term Infants

PEDIATRICS ◽  
1995 ◽  
Vol 96 (1) ◽  
pp. 64-68
Author(s):  
J. Groswasser ◽  
M. Sottiaux ◽  
E. Rebuffat ◽  
T. Simon ◽  
M. Vandeweyer ◽  
...  
Keyword(s):  
Eye Movement ◽  
Preterm Infants ◽  
Upper Airway ◽  
Periodic Breathing ◽  
Full Term ◽  
Rapid Eye Movement ◽  
Term Infants ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Obstructive Sleep Apneas

Objective. To investigate the effect of body rocking on infant respiratory behavior during sleep. Methods. Eighteen infants with documented obstructive sleep apneas were studied. There were eight premature infants with persistent bradycardias and 10 infants born full-term, admitted after an idiopathic apparent life-threatening event. No cause for the obstructive apneas was found. The infants were recorded with polygraphic techniques during two successive nights. They were randomly assigned to a rocking or a nonrocking mattress. The conditions were reversed the following night, in a crossover design. Results. In both groups of infants, no significant difference was seen between the two consecutive nights for most of the variables studied: total sleep time, the proportion of non-rapid-eye-movement and rapid-eye-movement sleep, the number of arousals, the number and maximal duration of central apneas, the frequency of periodic breathing, the level of oxygen saturation, and heart rate. During the nonrocking nights, all infants had repeated obstructive breathing events. In seven of the eight preterm infants and in nine of the 10 full-term subjects, body rocking was associated with a significant decrease in the frequency of obstructive events. During rocking, in the preterm infants the obstructions fell from a median of 2.5 to 1.8 episodes per hour (P = .034). In the full-term infants, rocking reduced the obstructive events from a median of 1.5 obstructions per hour to 0.7 (P = .005). No difference was seen for the duration of the obstructive episodes. Conclusion. In preterm and full-term infants prone to obstructive sleep apneas, gentle side-to-side body rocking is associated with a significant decrease in the frequency of upper-airway obstructions.

Effect of peripheral chemoreceptor denervation on acclimatization of goats during hypoxia

1981 ◽  
Vol 50 (2) ◽  
pp. 392-398 ◽  
Author(s):  
H. V. Forster ◽  
G. E. Bisgard ◽  
J. P. Klein
Keyword(s):  
Sea Level ◽  
Chronic Hypoxia ◽  
Alveolar Ventilation ◽  
Simulated Altitude ◽  
Peripheral Chemoreceptor ◽  
Peripheral Chemoreceptors ◽  
Carotid Chemoreceptors ◽  
Co2 Output

The purpose of this study was to determine the effect of peripheral chemoreceptor denervation on ventilatory acclimatization of goats during chronic hypoxia. After 1 h of stimulated altitude (PB 450 Torr), arterial O2 tension (PaO2) in seven normal goats averaged 42 Torr, and arterial CO2 tension (PaCO2) was 1.3 Torr below control (P less than 0.001). In these goats nearly 66% of the increase in alveolar ventilation (VA) associated with acclimatization occurred between 1.5 and 4 h of hypoxia. Acclimatization was complete by the 3rd day of hypoxia, and it caused 1) a 23% increase in VA/CO2 output (P less than 0.001); 2) a 5-Torr increase in PaO2 (P less than 0.001); and 3) a 6.5-Torr decrease in PaCO2 (P less than 0.001). Denervation of the carotid chemoreceptors in seven goats caused hypoventilation during eupnea at sea level (PaCO2 change from control +7 Torr, P less than 0.001). Denervation also attenuated but did not eliminate peripheral chemoreceptor responsiveness. No additional changes were observed following attempted denervation of the aortic chemoreceptors. After 1 h of simulated altitude (PB 530 Torr), PaO2 in the denervated goats averaged 46 Torr, and PaCO2 was increased 1.1 Torr above control (P less than 0.001). In these goats VA did not change significantly during the subsequent 3 days of hypoxia. Accordingly, we conclude that the peripheral chemoreceptors are essential for ventilatory acclimatization of goats during chronic hypoxia.

Breathing, transcutaneous blood gases, and CO2 response in SIDS siblings and control infants during sleep

1993 ◽  
Vol 74 (1) ◽  
pp. 88-102 ◽  
Author(s):  
T. Schafer ◽  
D. Schafer ◽  
M. E. Schlafke
Keyword(s):  
Blood Gases ◽  
Periodic Breathing ◽  
Sleep Time ◽  
Sudden Infant Death ◽  
Sudden Infant ◽  
Breathing Patterns ◽  
Co2 Response ◽  
Cross Sectional ◽  
Apnea Duration ◽  
Age Related

Age-related changes of 20 variables describing breathing patterns, transcutaneous blood gases, and estimated CO2 response during sleep were examined in a cross-sectional study of 30 healthy control infants and 150 healthy siblings of sudden infant death syndrome victims within the first 18 mo of life. Whole-night measurements were performed using noninvasive respiratory induction plethysmography and transcutaneous blood gas electrodes. Each candidate for the study was extensively screened and found to be healthy. Mean transcutaneous PCO2 (PtcCO2, median 40.3 Torr) and maximum PtcCO2 (median 44.8 Torr), as well as the estimated ventilatory response to inhalation of 2% CO2 in air during regular breathing, causing a 20–36% increase of ventilation per Torr PtcCO2, were not related to postnatal age. In contrast, paradoxical breathing decreased from 49.5 to 0% of total sleep time (TST), periodic breathing from 5.5 to 0% TST, and respiratory rate during regular breathing from 40 to 22 breaths/min; the portion of regular breathing increased from 32 to 55% TST and mean and minimum transcutaneous PO2 from 65.4 and 47 to 69.7 and 52 Torr with increasing stability. The largest changes occurred in the first 6 mo of life. Maximum apnea duration (9.5 s, maximum 16 s), mean apnea duration (3.74 s, breathing pauses > or = 2 s), and time spent apneic per hour of irregular breathing (199 s/h) were not related to age. The comparison of data from siblings and controls showed similarities in the above-mentioned variables. No significant differences were found among the groups. Also a comparison of 30 pairs of siblings and controls, matched for age, gender, birth, and actual body weight, did not show significant differences. The present study extends the knowledge of development of breathing control beyond the first 6 mo of life.

Sign in / Sign up

Export Citation Format

Share Document