Longitudinal Assessment of Hemoglobin Oxygen Saturation in Preterm and Term Infants in the First Six Months of Life

Hunt, Carl E.; Corwin, Michael J.; Weese‐Mayer, Debra E.; Ward, Sally L. Davidson; Ramanathan, Rangasamy; Lister, George; Tinsley, Larry; Heeren, Timothy; Rybin, Denis

doi:10.1016/j.jpeds.2011.02.011

Cited by 47 publications

(26 citation statements)

References 22 publications

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“…Many premature infants born at < 34 weeks gestation are exposed to similar levels of IH associated with apnea of prematurity and especially periodic breathing (3) which can persist beyond term equivalent age and is frequently not apparent (2, 40). Our data suggest that there may be significant deleterious effects of this persisting IH, but future studies in human infants born preterm are needed to determine if persisting IH due to immature breathing also causes acute injury and more importantly, whether this acute injury is associated with long term neurodevelopmental impairment.…”

Section: Discussionmentioning

confidence: 99%

Early postnatal exposure to intermittent hypoxia in rodents is proinflammatory, impairs white matter integrity, and alters brain metabolism

et al. 2017

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BackgroundPreterm infants are frequently exposed to intermittent hypoxia (IH) associated with apnea and periodic breathing that may result in inflammation and brain injury that later manifests as cognitive and executive function deficits. We used a rodent model to determine whether early postnatal exposure to IH would result in inflammation and brain injury.MethodsRat pups were exposed to IH from P2–P12. Control animals were exposed to room air. Cytokines were analyzed in plasma and brain tissue at P13 and P18. At P20–P22, diffusion tensor imaging (DTI) and magnetic resonance spectroscopy (MRS) were performed.ResultsPups exposed to IH had increased plasma Gro/CXCL1 and cerebellar IFN-γ and IL-1β at P13, and brainstem enolase at P18. DTI showed a decrease in FA and AD in the corpus callosum (CC) and cingulate gyrus and an increase in RD in the CC. MRS revealed decreases in NAA/Cho, Cr, Tau/Cr and Gly/Cr and increases in TCho and GPC in the brainstem and decreases in NAA/Cho in the hippocampus.ConclusionsWe conclude that early postnatal exposure to IH, similar in magnitude experienced in human preterm infants, is associated with evidence for pro-inflammatory changes, decreases in white matter integrity, and metabolic changes consistent with hypoxia.

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Section: Discussionmentioning

confidence: 99%

Early postnatal exposure to intermittent hypoxia in rodents is proinflammatory, impairs white matter integrity, and alters brain metabolism

et al. 2017

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“…Even healthy young infants have been documented to have intermittent desaturations to < 90%. (61, 62) Therefore, continuous pulse oximetry may detect hypoxemia of unclear significance in young infants with bronchiolitis, thereby prolonging the hospitalization. (56, 57) Avoiding continuous pulse oximetry in infants who are not on oxygen may help reduce excessive hospital days.…”

Section: Supportive Therapiesmentioning

confidence: 99%

Recent evidence on the management of bronchiolitis

Schroeder

Mansbach²

2014

Current Opinion in Pediatrics

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Purpose of Review Bronchiolitis is a common condition in children < 2 years and is a leading cause of infant hospitalization. While there is significant variability in testing and treatment of children with bronchiolitis, diagnostic testing rarely improves care, and no currently available pharmacologic options have been proven to provide meaningful benefit or improve outcomes. Recent Findings Beta-agonists continue to be used frequently despite evidence that they do not reduce hospital admissions or length-of-stay. In general, therapies initially considered promising were subsequently proven ineffective, a pattern seen in studies on corticosteroids, and more recently with nebulized racemic epinephrine and hypertonic saline. Recent research has improved our understanding of the viral epidemiology of bronchiolitis, with increasing recognition of viruses other than respiratory syncytial virus and better awareness of the role of viral co-infections. How these findings will translate into improved outcomes remains uncertain. Summary Much of the emphasis of the last few decades of bronchiolitis clinical care and research has centered on the identification and testing of novel therapies. Future quality improvement efforts should focus more on the limitation of unnecessary testing and treatments. Future research should include identification of subgroups of children with bronchiolitis that may benefit from focused clinical interventions.

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“…In the most recent systematic review investigating oxygen saturation monitoring in infants, the upper limit noted in otherwise healthy newborns for desaturations <80% for any length of time was found to be 14.7 episodes per hour at one day of age (16). In 2011, Hunt et al (17) described episodes of hypoxemia, unrelated to apnea and bradycardia events, in 74% of preterm and 62% of term infants.These events were very similar to those we observed in our study, given that very few failures were associated with bradycardia. Finally, there is lack of consistency in setting failure criteria.…”

Section: Data Presented As Mean ± Sd or N (%) Unless Otherwise Indicatedmentioning

confidence: 99%

Factors associated with car seat test failure in late preterm infants: A retrospective chart review

2016

Paediatrics and Child Health

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B oth the Canadian Paediatric Society and the AmericanAcademy of Pediatrics recommend a "car seat challenge" for preterm infants (<37 weeks' gestational age [GA]) before discharge from the hospital (1,2). Additional criteria often include full-term infants with significant neurological or cardiorespiratory disorders (3-5). Testing has been recommended in these populations following studies performed in the 1980s, which found that preterm neonates experienced periods of oxygen desaturation when placed in a semi-upright position, which persisted but improved once placed supine (6,7). In 1993, Bass et al (8) collected data over a 15-month period following implementation of a 90 min car seat test for all preterm infants in their level 2 nursery. Sixteen of 87 (18.4%) infants had abnormal results (the majority of which were desaturations <89%). This sample included seven of 33 (21.2%) infants of 36 weeks' GA (8). A more recent study identified that late preterm infants (LPIs, infants 34 0/7 to 36 6/7 weeks' GA) have higher failure rates than preterm infants with lower GAs (9). The hypothesis for increased failure rates is that LPIs are tested at younger postnatal ages, allowing less time for physiological maturation. Second, infants born more preterm are usually admitted to the neonatal intensive care unit (NICU), undergo prolonged periods of monitoring, and are tested when stable and ready for BACKgROunD: Professional organizations recommend car seat testing of preterm infants before discharge from hospital. Late preterm infants (LPIs, 34 0/7 to 36 6/7 weeks' gestational age) are at the greatest risk for failure, despite often being well. OBJECTIVE: To determine the incidence of car seat testing failure in LPIs and associative factors. METHODS: A retrospective chart review was performed of inborn LPIs admitted to all levels of newborn care between July 1, 2012 and June 30, 2013. Data collected included maternal demographics, labour and delivery history, and neonatal course. Data were analyzed using backward logistic regression. RESuLTS: A total of 511 charts were reviewed and 367 LPIs were eligible for inclusion. Of the 313 LPIs tested (mean [± SD] gestational age 36 weeks ±6 days and birth weight 2614±405 g), 80 (26%) failed (95% CI 21% to 31% Ideally, infants should be tested after an appropriate transitional period. The authors identified factors that may be important in designing future, prospective studies in this area. Future research should evaluate the clinical significance of car seat testing and resource utilization.

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Longitudinal Assessment of Hemoglobin Oxygen Saturation in Preterm and Term Infants in the First Six Months of Life

Cited by 47 publications

References 22 publications

Early postnatal exposure to intermittent hypoxia in rodents is proinflammatory, impairs white matter integrity, and alters brain metabolism

Early postnatal exposure to intermittent hypoxia in rodents is proinflammatory, impairs white matter integrity, and alters brain metabolism

Recent evidence on the management of bronchiolitis

Factors associated with car seat test failure in late preterm infants: A retrospective chart review

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