Dynamics of breathing in infants

Mortola, Jacopo P.; Fisher, John T.; Smith, Bruce A.; Fox, Gordon S.; Weeks, Sally K.

doi:10.1152/jappl.1982.52.5.1209

Cited by 162 publications

(56 citation statements)

References 21 publications

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“…The variability of the diaphragmatic muscle activity in infants was higher in CLD in comparison with the healthy infants at a similar sleep stage. are consistent with previous observations, which found that infants have a high capacity to dynamically maintain their lung volume (15)(16)(17). Postinspiratory muscle activity and ramp inspiratory muscle activity during expiration are important to actively control end-expiratory level in infants (17)(18)(19).…”

Section: Discussionsupporting

confidence: 92%

“…are consistent with previous observations, which found that infants have a high capacity to dynamically maintain their lung volume (15)(16)(17). Postinspiratory muscle activity and ramp inspiratory muscle activity during expiration are important to actively control end-expiratory level in infants (17)(18)(19). Our current findings suggest that infants with CLD attempt to control their end-expiratory level by using different breathing strategies and different respiratory muscle activation patterns, compared with those used by healthy infants.…”

Section: Discussionsupporting

confidence: 92%

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Respiratory Muscle Activity Related to Flow and Lung Volume in Preterm Infants Compared With Term Infants

et al. 2010

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Infants with chronic lung disease (CLD) have a capacity to maintain functional lung volume despite alterations to their lung mechanics. We hypothesize that they achieve this by altering breathing patterns and dynamic elevation of lung volume, leading to differences in the relationship between respiratory muscle activity, flow and lung volume. Lung function and transcutaneous electromyography of the respiratory muscles (rEMG) were measured in 20 infants with CLD and in 39 healthy age-matched controls during quiet sleep. We compared coefficient of variations (CVs) of rEMG and the temporal relationship of rEMG variables, to flow and lung volume [functional residual capacity (FRC)] between these groups. The time between the start of inspiratory muscle activity and the resulting flow (t ria )-in relation to respiratory cycle time-was significantly longer in infants with CLD. Although FRC had similar associations with t ria and postinspiratory activity (corrected for respiratory cycle time), the CV of the diaphragmatic rEMG was lower in CLD infants (22.6 versus 31.0%, p ϭ 0.030). The temporal relationship of rEMG to flow and FRC and the loss of adaptive variability provide additional information on coping mechanisms in infants with CLD. This technique could be used for noninvasive bedside monitoring of CLD. (Pediatr Res 68: 339-343, 2010) C hronic lung disease (CLD) of infancy represents the final common pathway of a heterogeneous group of pulmonary diseases that start in the neonatal period and usually evolve from acute respiratory disorders experienced by newborn infants (1). Tidal breathing parameters, lung volume, and ventilation homogeneity are affected by the morphologic changes in CLD and can be measured by lung function studies. Some studies showed decreased endexpiratory volume [functional residual capacity (FRC)] and lung clearance index (LCI) (2) in sedated infants, whereas other studies in infants during natural sleep could not confirm these observed differences in FRC and LCI between healthy infants and infants with CLD (3). We (4) and other authors (3) indicated that the latter findings are in line with the following clinical observations: infants with CLD in natural sleep may have a high capacity to maintain relatively normal lung volume and relatively normal gas exchange, despite alterations to their lung mechanics, whereas this capacity may be reduced during sedation.Recently, we described the combination of matched tidal breathing measurements and transcutaneous electromyography of the respiratory muscles (rEMG) in healthy infants (5). Our findings suggested that the interaction of the respiratory muscles and lung mechanics are actively controlled breath to breath and that simultaneous measurement of tidal breathing parameters and rEMG parameters potentially provide a more comprehensive picture of pulmonary mechanics in disease. We hypothesize that infants with CLD attempt to maintain a relatively normal lung volume by altering breathing patterns and dynamical elevation of lung volume. Thes...

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Respiratory Muscle Activity Related to Flow and Lung Volume in Preterm Infants Compared With Term Infants

et al. 2010

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“…These studies demonstrated that the first breaths tend to be deeper and longer than subsequent breaths and are characterized by a short deep inspiration followed by a prolonged expiratory phase. This is known as expiratory braking and helps to develop and maintain functional residual capacity (FRC) during the immediate newborn period when the lung is partially liquid filled and the chest wall is very compliant (9,10). Although this respiratory pattern has also been observed in preterm and term infants later in life (11)(12)(13)(14)(15), there are no data describing the breathing pattern of very preterm infants immediately after birth.…”

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confidence: 99%

Breathing Patterns in Preterm and Term Infants Immediately After Birth

et al. 2009

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There is limited data describing how preterm and term infants breathe spontaneously immediately after birth. We studied spontaneously breathing infants Ն29 wk immediately after birth. Airway flow and tidal volume were measured for 90 s using a hot wire anemometer attached to a facemask. Twelve preterm and 13 term infants had recordings suitable for analysis. The median (interquartile range) proportion of expiratory braking was very high in both groups (preterm 90 ͓74 -99͔ vs. term 87 ͓74 -94͔%; NS). Crying pattern was the predominant breathing pattern for both groups (62 ͓36 -77͔% vs. 64 ͓46 -79͔%; NS). Preterm infants showed a higher incidence of expiratory hold pattern (9 ͓4 -17͔% vs. 2 ͓0 -6͔%; p ϭ 0.02). Both groups had large tidal volumes (6.7 ͓3.9͔ vs. 6.5 ͓4.1͔ mL/kg), high peak inspiratory flows (5.7 ͓3.8͔ vs. 8.0 ͓5͔ L/min), lower peak expiratory flow (3.6 ͓2.4͔ vs. 4.8 ͓3.2͔ L/min), short inspiration time (0.31 ͓0.13͔ vs. 0.32 ͓0.16͔ s) and long expiration time (0.93 ͓0.64͔ vs. 1.14 ͓0.86͔ s). Directly after birth, both preterm and term infants frequently brake their expiration, mostly by crying. Preterm infants use significantly more expiratory breath holds to defend their lung volume. (Pediatr Res 65: 352-356, 2009)

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“…The pattern of mid-to late expiratory braking with a rapid increase in expiratory flow during late expiration described in our preterm infants at 3 wk of age has been observed to be more prominent during the first hours of life in full-term infants (29). Expiratory braking may also be of particular importance in neonates because they have increased chest wall compliance and a need to maintain end expiratory lung volume above their resting lung volumes (9,10). Persistence of DIA braking during C 0 2 inhalation may be a strategy used by preterm infants for active maintenance of an elevated lung volume.…”

Section: Resultsmentioning

confidence: 99%

Control of Laryngeal Muscle Activity in Preterm Infants

et al. 1987

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Laryngeal muscle activity may be an important determinant of breathing patterns in infants. it has been proposed that retardation of expiratory flow (expiratory braking) and grunting, characteristic of neonates with respiratory distress, are accomplished by active laryngeal adduction (8). Healthy preterm and term infants are also able to control expiratory flow in order to actively maintain end expiratory lung volume above the resting lung volume (9, lo), although the relative contributions of laryngeal and diaphragmatic mechanisms to this regulation of lung volume are unclear. The purpose of this investigation was to determine the response of the laryngeal muscles and the diaphragm in healthy preterm infants to changes in respiratory drive and their resultant effects on airflow patterns. METHODSStudies were performed on 12 preterm infants free of cardiorespiratory problems at the time of study. Mean gestational age at birth was 32 5 2 wk (mean + SD) as determined from both maternal history and physical and neurological examination.The subjects were studied at a postnatal age of 21 + 8 days when their weight was 1.7 .t 0.2 kg. All infants were breathing room air at the time of study, although six had recovered from respiratory distress syndrome.

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Dynamics of breathing in infants

Cited by 162 publications

References 21 publications

Respiratory Muscle Activity Related to Flow and Lung Volume in Preterm Infants Compared With Term Infants

Respiratory Muscle Activity Related to Flow and Lung Volume in Preterm Infants Compared With Term Infants

Breathing Patterns in Preterm and Term Infants Immediately After Birth

Control of Laryngeal Muscle Activity in Preterm Infants

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