Apnea in Premature Infants and Incubator-Air-Temperature Changes

Perlstein, Paul H; Edwards, Neil K.; Sutherland, James M.

doi:10.1056/nejm197002262820901

Cited by 142 publications

(48 citation statements)

References 6 publications

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“…In our study, the relationship between apneic parameters and the thermal drive is not related to body temperatures but, rather, to the BHL (for each thermal condition as well as in each sleep state), confirming the hypothesis of Perlstein et al 9 Although the regression coefficients for the different relationships were significant, they only explain between 6% and 31% of the observed variance. This emphasizes the physiologic variability commonly found in the growing organism, due to differences…”

Section: Thermal Metabolic and Hypnic Parameterssupporting

confidence: 89%

“…8,9,11,41 With the exception of the work by Bader et al 11 , most of these studies did not look for (or did not demonstrate) significant warm thermal effects on apnea duration, as confirmed by our results when comparing thermoneutrality and warm exposure. The mechanisms of the impact of warm stimuli on apneic episodes have not been elucidated.…”

Section: Thermal Metabolic and Hypnic Parameterssupporting

confidence: 80%

“…Any failure to maintain thermal balance stimulates the body's thermal control mechanisms and thus triggers regulatory adjustments. This approach may help clarify a hypothesis raised by Perlstein et al, 9 whereby apnea is not specifically induced by changes in air temperature but, rather, through processes controlling the overall body heat loss (BHL). Hence, in the present study, the role of thermal drive in the mechanisms underlying the genesis of central apnea in the sleeping neonate was assessed by taking into account BHL during mild warm and cool thermal exposures.…”

Section: In Neonates the Incidence Of Apnea Depends On A Variety Of mentioning

confidence: 95%

“…3,4 Central apnea is generally reported as occurring more frequently during active sleep than during quiet sleep. 2,3,[5][6][7] Many authors have pointed out that apnea incidence is also closely related to ambient temperature in both full-term [8][9][10] and preterm neonates 9,11,12 and that the rate of apneic events is increased by warm exposure (i.e., thermal drive). Although preterm neonates are more often exposed to cool stress than to warm stress, little is known about the influence of cool exposure on the incidence of apnea in the different sleep states.…”

Section: In Neonates the Incidence Of Apnea Depends On A Variety Of mentioning

confidence: 99%

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Influence of Thermal Drive on Central Sleep Apnea in the Preterm Neonate

Tourneux

Cardot

Museux

et al. 2008

Sleep

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549 IN NEONATES, THE INCIDENCE OF APNEA DEPENDS ON A VARIETY OF FACTORS, SUCH AS BIRTH WEIGHT, 1 SEX, 2 GESTATIONAL AGE, 3 AND POSTNATAL AGE. 3,4 Central apnea is generally reported as occurring more frequently during active sleep than during quiet sleep. 2,3,[5][6][7] Many authors have pointed out that apnea incidence is also closely related to ambient temperature in both full-term [8][9][10] and preterm neonates 9,11,12 and that the rate of apneic events is increased by warm exposure (i.e., thermal drive). Although preterm neonates are more often exposed to cool stress than to warm stress, little is known about the influence of cool exposure on the incidence of apnea in the different sleep states. Bader et al 11 reported a lower rate of central apnea during transient decreases in incubator temperature from warm (29°C) to thermoneutral conditions (24°C) over 30 minutes, although this was only seen during quiet sleep for preterm infants and during active sleep for term infants.The mechanism linking thermal stress and apnea is unknown and thus warrants further investigation. On the basis of the above-cited studies, it can be supposed that suprapontine influences modify respiratory control, which must be considered as a multiple-interaction system. Abnormal functional interaction among the respiratory system, thermoregulatory system, and sleep processes may alter compensatory responses to autonomic cardiovascular or respiratory challenge and increase the likelihood of life-threatening events later in life. 13 The effect of thermal stress is usually assessed by monitoring the body's internal temperature (generally esophageal or rectal temperatures, which supposedly represent the core temperature) and/or mean skin temperature. 14 However, the central controller of the thermoregulatory system receives thermal inputs from thermosensitive structures distributed throughout the body. The regulated variable therefore results from a weighted sum of different body temperatures. 15 Hence, to fully understand the thermal influence on apnea incidence in cool environments, it is essential to quantify the magnitude of body cooling that is proportional to the radiant, convective, conductive, and evaporative heat losses (i.e., body heat loss) on the other. Any failure to maintain thermal balance stimulates the body's thermal control mechanisms and thus triggers regulatory adjustments. This approach may help clarify a hypothesis raised by Perlstein et al, 9 whereby apnea is not specifically induced by changes in air temperature but, rather, through processes controlling the overall body heat loss (BHL). Hence, in the present study, the role of thermal drive in the mechanisms underlying the genesis of central apnea in the sleeping neonate was assessed by taking into account BHL during mild warm and cool thermal exposures.Central apneic events were monitored in a group of 22 nearterm neonates. Indeed, there are few published studies on these infants, who are generally considered to be physiologically similar to term infants, even t...

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Section: Thermal Metabolic and Hypnic Parameterssupporting

confidence: 89%

Section: Thermal Metabolic and Hypnic Parameterssupporting

confidence: 80%

Section: In Neonates the Incidence Of Apnea Depends On A Variety Of mentioning

confidence: 95%

Section: In Neonates the Incidence Of Apnea Depends On A Variety Of mentioning

confidence: 99%

See 2 more Smart Citations

Influence of Thermal Drive on Central Sleep Apnea in the Preterm Neonate

Tourneux

Cardot

Museux

et al. 2008

Sleep

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“…A rapid increase in incubator air temperature and hyperthermia have been associated with respiratory instability. 24,25 Sleep is essential for normal infant growth and development, and infant body temperature biorhythm and sleep-wake pattern are closely related. 26 The effects of incubator operation mode may be reflected in an altered sleep-wake pattern.…”

Section: Summationmentioning

confidence: 99%

Preterm Infant Thermal Care: Differing Thermal Environments Produced by Air Versus Skin Servo-Control Incubators

Thomas

Burr

1999

J Perinatol

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OBJECTIVE:Incubator thermal environments produced by skin versus air servo-control were compared. STUDY DESIGN:Infant abdominal skin and incubator air temperatures were recorded from 18 infants in skin servo-control and 14 infants in air servo-control (26-to 29-week gestational age, 14 Ϯ 2 days postnatal age) for 24 hours. Differences in incubator and infant temperature, neutral thermal environment (NTE) maintenance, and infant and incubator circadian rhythm were examined using analysis of variance and scatterplots. RESULTS:Skin servo-control resulted in more variable air temperature, yet more stable infant temperature, and more time within the NTE. Circadian rhythm of both infant and incubator temperature differed by control mode and the relationship between incubator and infant temperature rhythms was a function of control mode. CONCLUSION:The differences between incubator control modes extend beyond temperature stability and maintenance of NTE. Circadian rhythm of incubator and infant temperatures is influenced by incubator control.Maintenance of body temperature is a primary challenge facing the preterm infant. Preterm infants are vulnerable to both overand under-heating resulting from limited heat production capacity, propensity for heat loss related to body configuration, skin maturation, and immature sudomotor responses. Incubators, the mainstay in providing thermal care for these fragile infants, operate in two modes: air and skin servo-control. 1,2 The choice of air versus skin servo-control is typically based on infant clinical parameters such as birth weight, gestational age, and health status, and unit protocol, individual care provider preference and experience, equipment availability, marketing, purchasing decisions, and trends in neonatal care.The research examining incubator control mode has focused essentially on the description of environmental temperature stability, efficacy in maintaining a neutral thermal environment (NTE), and minimizing oxygen consumption. In general, skin servo-control incubators produce incubator air temperatures that are extremely variable, often exhibiting a lag effect in response to infant temperature change and overshoot and undershoot. Excursions in incubator temperature greater than 2°C have been reported during skin servocontrol operation. 3,4 Variability in air temperature is also related, in part, to the discrepancy between air temperature, measured at the site of the thermostat, and the incubator temperature as a whole; specifically, air temperature recorded mid-incubator differs from temperature measured at the thermostat. 4 The variable air temperatures observed in skin servo-control incubators result in part from probe artifacts. 4 -7 The two types of artifact in skin temperature measurement are: (1) probe insulation, resulting in probe temperature falsely greater than skin surface temperature and consequently lower incubator (or radiant warmer) temperature, and (2) convective and radiant heating or cooling of the skin probe by the surrounding environment. ...

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Polygraphic Monitoring of Apneic Spells

Deuel¹

1973

Arch Neurol

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Apnea in Premature Infants and Incubator-Air-Temperature Changes

Cited by 142 publications

References 6 publications

Influence of Thermal Drive on Central Sleep Apnea in the Preterm Neonate

Influence of Thermal Drive on Central Sleep Apnea in the Preterm Neonate

Preterm Infant Thermal Care: Differing Thermal Environments Produced by Air Versus Skin Servo-Control Incubators

Polygraphic Monitoring of Apneic Spells

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