Developmental consequences of short apneas and periodic breathing in preterm infants

Yee, Alicia K.; Siriwardhana, Leon S.; Nixson, Gillian M.; Walter, Lisa M.; Wong, Flora Y.; Horne, Rosemary S. C.

doi:10.1038/s41372-023-01748-8

Cited by 6 publications

(4 citation statements)

References 48 publications

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“…Several studies have shown associations between reduced cerebral oxygenation during the neonatal period and neurodevelopmental outcomes 26–29 however not all have shown this link, probably because of differences in the level and duration of hypoxia 30 . In this same group of infants, we have shown that the time spent with central apnoeas, specifically with periodic breathing at 36–40 PMA, was negatively associated with language and motor scores at 6 months CA 13 …”

Section: Discussionmentioning

confidence: 56%

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Preterm infants experience a nadir in cerebral oxygenation during sleep three months after hospital discharge

Yee,

Shetty,

Siriwardhana

et al. 2024

Acta Paediatrica

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AimPreterm infants are at increased risk of Sudden Infant Death Syndrome (SIDS) and frequently experience short central apnoeas which can occur in isolation or a repetitive pattern (periodic breathing). We investigated the relationship between central apnoeas experienced before and over the 6 months after hospital discharge and cerebral oxygenation.MethodsPreterm infants born between 28 and 32 weeks gestational age (GA) were studied during supine daytime sleep at 32–36 weeks post menstrual age (PMA) (n = 40), 36–40 weeks PMA (n = 27), 3‐months corrected age (CA) (n = 20) and 6‐months CA (n = 26). Cerebral tissue oxygenation (TOI), peripheral oxygenation (SpO2) and heart rate were recorded continuously. The percentage total sleep time (%TST) spent having central apnoeas at each study and cerebral fractional oxygen extraction (SpO2‐TOI/SpO2) were calculated.Results%TST spent with central apnoeas decreased with increasing age in both active sleep (AS) and quiet sleep (QS). TOI tended to be lower and cerebral fractional oxygen extraction higher at 3 months compared to the other studies and this reached statistical significance compared to 32–36 weeks in QS.ConclusionThe nadir in cerebral tissue oxygenation at 3 months of age coincides with the peak risk period for SIDS and this may contribute to increased risk in these infants.

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Section: Discussionmentioning

confidence: 56%

“…Parents gave written informed consent before the first study. We have previously reported the risk factors for periodic breathing, 12 measurements of cerebral oxygenation during periods of periodic breathing 11 and the relationship between time spent with apnoea and developmental outcomes 13 in this cohort of infants.…”

Section: Methodsmentioning

confidence: 98%

Preterm infants experience a nadir in cerebral oxygenation during sleep three months after hospital discharge

Yee,

Shetty,

Siriwardhana

et al. 2024

Acta Paediatrica

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“…In China, the rate of preterm birth is also on the rise ( 4 ). Each year, approximately 1.1 million newborns die from preterm birth ( 5 ) and its related complications, including respiratory distress syndrome ( 6 ), apnea ( 7 ), metabolic disorders, anemia, and feeding intolerance ( 8 ). Even infants who survive may suffer from long-term sequelae such as growth retardation, chronic lung disease, cerebral palsy, and more, posing a significant economic burden on families and society ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

Maternal cobalt concentration and risk of spontaneous preterm birth: the role of fasting blood glucose and lipid profiles

Huang,

Zheng,

Wang

et al. 2024

Front. Nutr.

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IntroductionSpontaneous preterm birth (SPB) is a significant cause of neonatal mortality, yet its etiology remains unclear. Cobalt, an essential trace element, might be a risk factor for SPB. This study aims to investigate the relationship between maternal serum cobalt concentration and SPB, and to clarify the role of blood lipids and fasting blood glucose (FBG) in this relationship.MethodsWe conducted a nested case-control study within the Beijing Birth Cohort Study. Serum samples were obtained from 222 pregnant women with SPB and 224 controls during the first (7–13 weeks of pregnancy) and third trimesters (32–42 weeks of pregnancy). Serum cobalt concentration was determined using inductively coupled plasma mass spectrometry (ICP-MS). Fasting blood glucose and lipids levels were detected using a fully automated biochemical immunoassay instrument. Logistic regression models and linear regression models were established to explore the association between serum cobalt concentration and the risk of SPB in pregnant women, and to test the mediating effect of fasting blood glucose (FBG) and lipids.ResultsWe found that the serum cobalt concentration in mothers with SPB and controls was similar in the first trimester, with values of 0.79 (0.58–1.10) ng/mL and 0.75 (0.51–1.07) ng/mL, respectively. However, in the third trimester, the cobalt concentration increased to 0.88 (0.59–1.14) ng/mL and 0.84 (0.52–1.19) ng/mL, respectively. In the logistic regression model, when considering the third trimester of pregnancy, after adjusting for ethnicity, pre-pregnancy body mass index (BMI), maternal age, education, income, and parity, it was observed that the medium level of cobalt concentration (0.63–1.07 ng/ml) had a negative correlation with the risk of SPB. The odds ratio (OR) was 0.56, with a 95% confidence interval of 0.34–0.90 ng/mL and a p-value of 0.02. This suggests that cobalt in this concentration range played a protective role against SPB. Additionally, it was found that FBG in the third trimester of pregnancy had a partial intermediary role, accounting for 9.12% of the association. However, no relationship between cobalt and SPB risk was found in the first trimester.ConclusionDuring the third trimester, intermediate levels of maternal cobalt appear to offer protection against SPB, with FBG playing a partial mediating role. To further clarify the optimal cobalt concentrations during pregnancy for different populations, a multi-center study with a larger sample size is necessary. Additionally, exploring the specific mechanism of FBG’s mediating role could provide valuable insights for improving the prevention of SPB.

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“…These events, characterized by breathing interruptions and associated bradycardia, can result in hypoxemia and cerebral hypoperfusion, posing immediate threats to the infant's well-being [8]. Furthermore, the long-term consequences extend to potential neurodevelopmental disorders, which are well documented in preterm infants [8,9]. Bradycardia contributes substantially to morbidity and mortality in this vulnerable population [10].…”

Section: Introductionmentioning

confidence: 99%

Bradycardia May Decrease Cardiorespiratory Coupling in Preterm Infants

Porta-García,

Quiroz-Salazar,

Abarca-Castro

et al. 2023

Entropy

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Bradycardia, frequently observed in preterm infants, presents significant risks due to the immaturity of their autonomic nervous system (ANS) and respiratory systems. These infants may face cardiorespiratory events, leading to severe complications like hypoxemia and neurodevelopmental disorders. Although neonatal care has advanced, the influence of bradycardia on cardiorespiratory coupling (CRC) remains elusive. This exploratory study delves into CRC in preterm infants, emphasizing disparities between events with and without bradycardia. Using the Preterm Infant Cardio-Respiratory Signals (PICS) database, we analyzed interbeat (R-R) and inter-breath intervals (IBI) from 10 preterm infants. The time series were segmented into bradycardic (B) and non-bradycardic (NB) segments. Employing information theory measures, we quantified the irregularity of cardiac and respiratory time series. Notably, B segments had significantly lower entropy values for R-R and IBI than NB segments, while mutual information was higher in NB segments. This could imply a reduction in the complexity of respiratory and cardiac dynamics during bradycardic events, potentially indicating weaker CRC. Building on these insights, this research highlights the distinctive physiological characteristics of preterm infants and underscores the potential of emerging non-invasive diagnostic tools.

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Developmental consequences of short apneas and periodic breathing in preterm infants

Cited by 6 publications

References 48 publications

Preterm infants experience a nadir in cerebral oxygenation during sleep three months after hospital discharge

Preterm infants experience a nadir in cerebral oxygenation during sleep three months after hospital discharge

Maternal cobalt concentration and risk of spontaneous preterm birth: the role of fasting blood glucose and lipid profiles

Bradycardia May Decrease Cardiorespiratory Coupling in Preterm Infants

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