Objectives Our goal was to evaluate changes in respiratory pattern among premature infants born at less than 29 weeks gestation who underwent a physiologic challenge at 36 weeks post-menstrual age with systematic reductions in supplemental oxygen and inspired airflow. Study Design Subjects were all infants enrolled in the Prematurity and Respiratory Outcomes Program at St. Louis Children’s Hospital and eligible for a physiologic challenge protocol because they were receiving supplemental oxygen or augmented airflow alone as part of their routine care. Continuous recording of rib cage and abdominal excursion and hemoglobin oxygen saturation (SpO2%) were made in the newborn intensive care unit. Results Thirty seven of 49 infants (75.5%) failed the challenge, with severe or sustained falls in SpO2%. And 16 of 37 infants (43.2%) who failed had marked increases in the amount of periodic breathing at the time of challenge failure. Conclusions An unstable respiratory pattern is unmasked with a decrease in inspired oxygen or airflow support in many premature infants. Although infants with significant chronic lung disease may also be predisposed to more periodic breathing, these data suggest that the classification of chronic lung disease of prematurity based solely on clinical requirements for supplemental oxygen or airflow do not account for multiple mechanisms that are likely contributing to the need for respiratory support.

Behavioral hyperventilation is a rarely recognized cause of central sleep apnea (CSA) among children. We report two pediatric patients who presented with prolonged central sleep apnea secondary to behavioral hyperventilation. One patient also had a prolonged corrected QT (QT C ) interval resulting from hyperventilation.

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