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.

Retardation of Neuronal Maturation in Premature Infants Compared with Term Infants of the Same Postconceptional Age

PEDIATRICS ◽  
1982 ◽  
Vol 69 (1) ◽  
pp. 33-39
Author(s):  
Sachio Takashima ◽  
Laurence E. Becker ◽  
Fu-Wah Chan
Keyword(s):  
Premature Infants ◽  
Neuronal Development ◽  
Ductus Arteriosus ◽  
Sudden Infant Death ◽  
Neuronal Maturation ◽  
Sudden Infant ◽  
Term Infants ◽  
Postconceptional Age ◽  
Morphologic Development ◽  
Patent Ductus

Neuronal morphologic development and the number of soma and spines in the visual cortex were investigated. Ten premature infants surviving at least three weeks were compared with control infants who had been born at term gestation and had the same postconceptional age. In six cases of sudden infant death syndrome, bronchopulmonary dysplasia, or patent ductus arteriosus, neuronal development was similar to that in the control cases. The persistence of immature neurons in two of the remaining four cases suggested a developmental neuronal delay or arrest.

`Near-Miss' for Sudden Infant Death Syndrome Infants: A Clinical Problem

PEDIATRICS ◽  
1983 ◽  
Vol 71 (5) ◽  
pp. 726-730
Author(s):  
Ronald L. Ariagno ◽  
Christian Guilleminault ◽  
Rowena Korobkin ◽  
Margaret Owen-Boeddiker ◽  
Roger Baldwin
Keyword(s):  
Preterm Infants ◽  
Sudden Infant Death Syndrome ◽  
Infant Death ◽  
Specific Treatment ◽  
Sudden Infant Death ◽  
Near Miss ◽  
Sudden Infant ◽  
Term Infants ◽  
Medical Evaluation

Three hundred six infants were referred for evaluation of "near-miss" sudden infant death syndrome (SIDS) from 1973 to 1980. Following the hospitalization and medical evaluation, there were 156 infants (115 term and 41 preterm) for whom there was no explanation for the presenting event and who were considered near-miss infants; 88% of these infants were seen during the first 3 months of life. A repeat near-miss event was reported in 63% (term) and 83% (preterm) infants. Twelve percent of term infants and 17% of the preterm infants had ten or more repeat events. A home apnea/cardiac monitor was prescribed for 88% of the infants for an average duration of 5.6 months in term infants and 3.5 months in preterm infants. Monitoring had been discontinued in 69% of the infants by 7 months of age. One full-term infant was later a SIDS victim. The risk of a repeat nearmiss event is concluded to be sufficiently great to demand immediate hospitalization, medical evaluation, home monitoring when there is no specific treatment, and close clinical follow-up. Follow-up studies are needed to determine whether there is any long-term morbidity for infants who have had near miss events.

Statistical Evaluation of the Respiratory Pattern as a Risk Factor for the Sudden Infant Death Syndrome

1984 ◽  
Vol 23 (01) ◽  
pp. 41-46 ◽  
Author(s):  
K. P. Pfeiffer ◽  
R. Haidmayer ◽  
P. Kerschhaggl ◽  
R. Kurz ◽  
T. Kenner
Keyword(s):  
Statistical Evaluation ◽  
Age Groups ◽  
Sudden Infant Death ◽  
Diagnostic Information ◽  
Respiratory Pattern ◽  
Sudden Infant ◽  
Numerical Classification ◽  
Clinical Classification ◽  
Classification Procedure ◽  
Characteristic Values

SummaryTo evaluate the respiratory pattern of infants with regard to a possible risk for SIDS, two characteristic values (MA and GA) were computed from the distribution of apneas. For the computation of one of these characteristic values (GA), a weight function for apneas was used to consider the diagnostic information content of apneas of different durations. The distribution of apneas is approximately exponential where apneas up to 20 s and longer have been found. Using these characteristic numerical values of the respiratory pattern, infants of different age groups were classified into risk and non-risk cases. This classification was performed in the way that an optimal agreement between clinical and numerical classification was achieved. For both numerical values an agreement of about 90% with clinical classification was achieved.To consider the differing impact of misclassification, a weighted classification procedure was proposed.

Cardiorespiratory Function in 16 Full-Term Infants With Sudden Infant Death Syndrome

PEDIATRICS ◽  
1986 ◽  
Vol 78 (5) ◽  
pp. 787-796
Author(s):  
D. P. Southall ◽  
J. M. Richards ◽  
V. Stebbens ◽  
A. J. Wilson ◽  
V. Taylor ◽  
...  
Keyword(s):  
Sudden Infant Death Syndrome ◽  
Infant Death ◽  
Matched Control ◽  
Periodic Breathing ◽  
Sudden Infant Death ◽  
Full Term ◽  
Sudden Infant ◽  
Breathing Patterns ◽  
Term Infants ◽  
Cardiorespiratory Function

Twenty-four-hour tape recordings of ECG and breathing movements from 16 term infants (≥37 weeks' gestation) who subsequently died of sudden infant death syndrome (SIDS) were compared with recordings from surviving infants from the same populations. Apneic pauses of varying durations, periodic and regular breathing patterns, heart and respiratory rates during regular breathing were measured. Only one of 16 full-term infants with SIDS had findings outside the range of age-matched control infants (an excess of periodic breathing patterns and an absence of regular breathing). When the first recordings of each of infants who died of SIDS, except one who had cyanotic episodes prior to death, were compared to recordings of survivors (six for each case) closely matched for age, gestation, and weight at birth, no differences in breathing patterns or heart or respiratory rates during regular breathing could be demonstrated. These particular measurements of cardiorespiratory function were, therefore, unable to identify the majority of full-term infants at risk for SIDS.

Apnea, Hypoxemia, and Aborted Sudden Infant Death Syndrome

PEDIATRICS ◽  
1978 ◽  
Vol 62 (5) ◽  
pp. 686-691
Author(s):  
June P. Brady ◽  
Ronald L. Ariagno ◽  
John L. Watts ◽  
Steven L. Goldman ◽  
Fe M. Dumpit
Keyword(s):  
Heart Rate ◽  
Sudden Infant Death Syndrome ◽  
Infant Death ◽  
Total Duration ◽  
Periodic Breathing ◽  
Sudden Infant Death ◽  
Control Group ◽  
Sudden Infant ◽  
Nasal Catheter ◽  
End Tidal

To find out whether there is any relationship between the ventilatory response to hypoxia and the sudden infant death syndrome (SIDS), we studied the effects of mild induced hypoxia (PIO2, 120 mm Hg = 17% oxygen) in 16 infants aged 2 weeks to 6 months. Eight had recurrent apneic spells (apnea group) (five had aborted SIDS and three had recurrent apnea in the intensive care nursery) and eight were "well" preterm infants about to fly in a pressurized airplane (PIO2, 120 mm Hg) (control group). Mean birth weights were 2,245 and 1,400 gm and mean gestational ages were 35 and 30 weeks. Postconceptual ages (41.8 and 41.3 weeks) were almost identical. Heart rate was obtained from an ECG, and respiratory rate and pattern were obtained from a pneumogram. In addition, end-tidal PCO2 and PN2 or PO2 were obtained with a nasal catheter and gas analyzers. In the apnea group with inhalation of 17% oxygen, we observed an increase in periodic breathing and an increase in both rate and total duration of respiratory pauses. In the control group there were no significant changes. Heart rate and PCO2 did not change in either group. Our findings suggest that infants prone to apnea may have unique respiratory responses to mild induced hypoxia.

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.

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.

scholarly journals HOME MONITORING DECREASES SUDDEN INFANT DEATH SYNDROME (SIDS) IN HIGH-RISK PRETERM INFANTS. 1669

1996 ◽  
Vol 39 ◽  
pp. 281-281
Author(s):  
Yolande Smith ◽  
Deborah Hoy ◽  
Ildiko Kunos ◽  
Maureen R Owens ◽  
Leslie Layne
Keyword(s):  
High Risk ◽  
Preterm Infants ◽  
Sudden Infant Death Syndrome ◽  
Infant Death ◽  
Home Monitoring ◽  
Sudden Infant Death ◽  
Sudden Infant

Hypoxic Arousal Responses in Normal Infants

PEDIATRICS ◽  
1992 ◽  
Vol 89 (5) ◽  
pp. 860-864 ◽  
Author(s):  
Sally L. Davidson Ward ◽  
Daisy B. Bautista ◽  
Thomas C. Keens
Keyword(s):  
Ventilatory Response ◽  
Arterial Oxygen Saturation ◽  
Periodic Breathing ◽  
High Risk Group ◽  
Arterial Oxygen ◽  
Sudden Infant ◽  
Hypoxic Ventilatory Response ◽  
Quiet Sleep ◽  
Term Infants ◽  
Increased Risk

Failure to arouse in response to hypoxia has been described in infants at increased risk for sudden infant death syndrome (SIDS) and has been suggested as a possible mechanism for SIDS. However, most SIDS victims are not in a high-risk group before death. Thus, if a hypoxic arousal disorder is an important contributor to SIDS, normal infants might fail to arouse from sleep in response to hypoxia. To test this hypothesis, the authors studied hypoxic arousal responses in 18 healthy term infants younger than 7 months of age (age 12.1 ± 1.7 [SEM] weeks; 56% girls). Hypoxic arousal challenges were performed during quiet sleep by rapidly decreasing inspired oxygen tension (Pio2) to 80 mm Hg for 3 minutes or until arousal (eye opening, agitation, and crying) occurred. Tests were performed in duplicate when possible. Only 8 infants (44%) aroused in response to one or more hypoxic challenges; arousal occurred during 8 (32%) of 25 trials. There were no significant differences in lowest Pio2 or arterial oxygen saturation during hypoxia between those infants who aroused and those who failed to arouse. All 18 infants had a fall in their end-tidal carbon dioxide tension during hypoxia, suggesting that each had a hypoxic ventilatory response despite failure to arouse in the majority. Periodic breathing occurred following hypoxia in only 1 (13%) of the 8 trials that resulted in arousal, compared with 16 (94%) of 17 trials without arousal (P < .005). It is concluded that the majority of normal infants younger than 7 months of age fail to arouse from quiet sleep in response to hypoxia, despite the apparent presence of a hypoxic ventilatory response.

Mixed and Obstructive Sleep Apnea and Near Miss for Sudden Infant Death Syndrome: 2. Comparison of Near Miss and Normal Control Infants by Age

PEDIATRICS ◽  
1979 ◽  
Vol 64 (6) ◽  
pp. 882-891 ◽  
Author(s):  
Christian Guilleminault ◽  
Ronald Ariagno ◽  
Rowena Korobkin ◽  
Lynn Nagel ◽  
Roger Baldwin ◽  
...  
Keyword(s):  
Normal Control ◽  
Sudden Infant Death Syndrome ◽  
Infant Death ◽  
Periodic Breathing ◽  
Sudden Infant Death ◽  
Near Miss ◽  
Sudden Infant ◽  
Obstructive Apnea ◽  
Respiratory Events ◽  
Obstructive Sleep

Twenty-nine full-term near miss for sudden infant death syndrome (SIDS) and 30 normal control infants underwent 24-hour polygraphic monitoring. Several types of respiratory events during sleep (eg, central, mixed, and obstructive apnea, periodic breathing) were defined and tabulated. Analysis of these respiratory variables and comparison of groups of near miss and control infants indicated that between 3 weeks and 4½ months of age only one variable was consistently different at a statistically significant level: the number of mixed and obstructive apnea 3 seconds during total sleep time. This study also showed an increase in mixed and obstructive respiratory events during sleep at 6 weeks of age in control as well as in near miss infants.

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