Airway closure during mixed apneas in preterm infants: Is respiratory effort necessary?

Idiong, Nnanake; Lemke, R; Lin, Yuh-Jyh; Kwiatkowski, Kim; Cates, Don; Rigatto, Henrique

doi:10.1016/s0022-3476(98)70058-7

Cited by 38 publications

(13 citation statements)

References 17 publications

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“…Milner et al, 52 utilizing the cardiac oscillation normally present on airflow channel, documented that the airway can become occluded even during central apnea. Further evidence confirming that inspiratory efforts are not essential in the development of upper airway obstruction was provided by Rigatto et al 53 Lack of upper airway muscle tone during the cessation of central respiratory drive is presumably responsible for this phenomenon.…”

Section: Neonatal Apnea Definition and Classificationmentioning

confidence: 73%

Apnea of prematurity: pathogenesis and management strategies

Mathew

2010

J Perinatol

110

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Apnea of prematurity (AOP) is a significant clinical problem manifested by an unstable respiratory rhythm reflecting the immaturity of respiratory control systems. This review will address the pathogenesis of and treatment strategies for AOP. Although the neuronal mechanisms leading to apnea are still not well understood, recent decades have provided better insight into the generation of the respiratory rhythm and its modulation in the neonate. Ventilatory responses to hypoxia and hypercarbia are impaired and inhibitory reflexes are exaggerated in the neonate. These unique vulnerabilities predispose the neonate to the development of apnea. Treatment strategies attempt to stabilize the respiratory rhythm. Caffeine remains the primary pharmacological treatment modality and is presumed to work through blockade of adenosine receptors A 1 and A 2 . Recent evidences suggest that A 2A receptors may have a greater role than previously thought. AOP typically resolves with maturation suggesting increased myelination of the brainstem.

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Section: Neonatal Apnea Definition and Classificationmentioning

confidence: 73%

Apnea of prematurity: pathogenesis and management strategies

Mathew

2010

J Perinatol

110

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“…42,43 We posit that such obstructions may simply refl ect the previously reported instability of the upper airway during hypoxia and CA that is typical in both premature infants and in very young full-term infants. 44 Alternatively, the intricate mechanisms governing upper airway function in the context of PB should also be mentioned. 42,45,46 Accordingly, with lower Sp o 2 values and a higher C-AHI (including PB) at Bogotá's altitude, it would not be unexpected to see a higher prevalence of obstructive episodes.…”

Section: Discussionmentioning

confidence: 99%

Overnight Polysomnographic Characteristics and Oxygen Saturation of Healthy Infants, 1 to 18 Months of Age, Born and Residing At High Altitude (2,640 Meters)

Duenas-Meza

Bazurto-Zapata

Gozal

et al. 2015

Chest

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“…In normal neonates the dominant respiratory strategy continues to focus on absolute lung volume maintenance (39,40). It has been speculated that the respiratory pattern of fetal quiet sleep may reappear at any age (41) and there is increasing awareness that upper airway closure can occur during prolonged apnea in the preterm neonate (42,43). This may be relevant in the sudden infant death syndrome (44) and emphasizes the need for investigation of central inputs that control laryngeal motoneurons (45).…”

Section: Discussionmentioning

confidence: 99%

Laryngeal Muscle Activities with Cerebral Hypoxia–Ischemia in Newborn Lambs

Hutchison¹,

Burchfield²,

Wozniak³

et al. 2002

Am J Respir Crit Care Med

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This study tested the hypotheses that (1) acute cerebral hypoxia-ischemia changes laryngeal adductor, laryngeal abductor, and diaphragmatic activities, resulting in central apnea with laryngeal closure; and (2) these laryngeal muscle activities act to maintain absolute lung volume. The respiratory pattern was determined in three asphyxiated, awake preterm lambs after cesarean section birth and in 12 awake, term lambs, with normal lung function, after induction of acute cerebral hypoxia-ischemia by occlusion of the brachiocephalic artery. Electrocorticogram activity, flow, volume, electromyograms of laryngeal abductor and adductor muscles and diaphragm, and, in the term lambs, trans-upper airway pressure and carotid blood flow were recorded. With either preterm birth asphyxia or induced acute cerebral hypoxia-ischemia, minute ventilation initially increased, and then hypopnea occurred. During the hypopnea, laryngeal adductor activity was prominent, accompanied by an increased upper airway pressure and a maintained/raised absolute lung volume. Thus, when acute hypoxia-ischemia limited to the upper body is induced in lambs with normal lung function, expiratory laryngeal adduction with closure of the upper airway occurs and likely functions to aid autoresuscitation.

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Airway closure during mixed apneas in preterm infants: Is respiratory effort necessary?

Cited by 38 publications

References 17 publications

Apnea of prematurity: pathogenesis and management strategies

Apnea of prematurity: pathogenesis and management strategies

Overnight Polysomnographic Characteristics and Oxygen Saturation of Healthy Infants, 1 to 18 Months of Age, Born and Residing At High Altitude (2,640 Meters)

Laryngeal Muscle Activities with Cerebral Hypoxia–Ischemia in Newborn Lambs

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