Periodic Breathing Cycle Duration in Preterm Infants

Glotzbach, Steven F.; Tansey, Patricia A.; Baldwin, Roger B.; Ariagno, Ronald L.

doi:10.1203/00006450-198903000-00007

Cited by 19 publications

(11 citation statements)

References 16 publications

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“…These findings are similar to those we (8,9) and others (7) have previously reported in term infants. Our data showing the decrease in PCD with maturation in preterm infants are clearly at variance with the study of Glotzbach et al (15) which showed no significant change in PCD with postnatal age in a group of 51 preterm infants. However, there are several methodologic differences between the two studies that might explain the discrepancies between them.…”

Section: Discussioncontrasting

confidence: 57%

Changes in the Temporal Structure of Periodic Breathing with Postnatal Development in Preterm Infants

et al. 1995

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The progressive decrease in the periodic cycle duration (PCD) of periodic breathing with postnatal age in term infants has been previously reported by a number of authors and is thought to be associated with peripheral chemoreceptor maturation. We hypothesized that a similar decrease should be observed in preterm infants. Therefore, in this study we measured the changes in PCD with postnatal age in a small group of preterm ( n = 4) infants followed longitudinally (36 afternoon nap studies) over the first 6 mo postnatally. PCD declined in these infants from 17.1 ? 3.3 s (mean -t-2 SD) at 9 d to 9.8 +-3.2 s (mean I 2 SD) at 105 d. The regression slope was -0.072 s/d. Beyond 105 d there was no change in PCD up to 6 mo postnatally. We found no significant difference between active and quiet sleep. These results are similar to results previously published in term infants but apparently contradict recent data on a group of preterm infants. Possible reasons for this discrepancy are discussed. By examining long epochs of periodic breathing in these infants we also identified characteristic changes in PCD and VIA ratio, defined as the duration of the ventilatory period divided by the duration of the apneic interval. VIA ratio fell from the start of an epoch from 1.21 2 0.08 (mean + SEM) to a minimum of 0.62 2 0.03 and then increased again to 0.8 -C 0.05 at the end of the epoch. We conclude that important maturational changes occu~ in the neonatal respiratory control system during the first 6 mo postnatally and that these changes are reflected in a fall in PCD of periodic breathing over this period. We also conclude that the characteristic changes which occur in VIA ratio and PCD are consistent with a role for chemical stimuli in the genesis of periodic breathing. (Pediatr Res 38: 533-538, 1995) Abbreviations SIDS, sudden infant death syndrome VIA, ratio of the duration of ventilation to the duration of apnea in one cycle of periodic breathing To, start time of a long epoch of periodic breathing Tmi,, time from To at which VIA ratio reaches its minimum value T,,,, end time of a long epoch of periodic breathing PCD, periodic breathing cycle duration A PCD, change in PCD during long epochs PNA, postnatal age PNA,,, postnatal age at which PCD ceases to decrease Sao,, arterial oxygen saturation ASao,, deviation between the mean Sao, and the peak or trough of the oscillation in Sao, during periodic breathing Periodic breathing has been studied extensively in both preterm and term infants. These studies have been aimed primarily at elucidating the causes of this type of breathing pattern in neonates and establishing the incidence during the first months of life (1,2).Much of the incentive for these studies came from earlier clinical observations that long apneas were often preceded by periodic breathing in preterm infants (3), although this finding has been disputed more recently (4). Also, a high incidence of periodic breathing has been reported in apparent life-threatening events and SIDS sibling infants when compared with ag...

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Section: Discussioncontrasting

confidence: 57%

Changes in the Temporal Structure of Periodic Breathing with Postnatal Development in Preterm Infants

et al. 1995

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“…In contrast to the situation in term infants, data on PCD maturation in preterm infants are contradictory. The current study and our earlier work (1) demonstrate PCD falls with PNA, whereas a study by Glotzbach et al (8) reported no change in PCD with PNA. The possible reasons for this discrepancy have been discussed in some detail previously (1).…”

Section: Discussioncontrasting

confidence: 54%

“…Also plotted in Figure 2, c and d, are published PCD data from previous studies. Note in Figure 2, c that the data of Glotzbach et al (8) show a rising trend with PNA, whereas our previous (1) and current data demonstrate a progressive fall in PCD with maturation; the single point is from Rigatto et al (13). All three existing studies in term infants (5-7) show a fall in PCD with PNA and are in good agreement with the regression curve derived from our current data (Fig.…”

Section: Resultscontrasting

confidence: 39%

“…However, another cross-sectional study of selected long epochs of PB in a larger group of preterm infants studied just before discharge from the nursery reported that PCD showed no trend or a weakly increasing trend over the first 3 mo postnatally (8); while the results of this study could be interpreted as conforming with the predictions of the Khoo model scaled to the infant, we have argued previously that the study design may have biased the outcome (1).…”

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confidence: 43%

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Postnatal Development of Periodic Breathing Cycle Duration in Term and Preterm Infants

Wilkinson

Skuza

Rennie³

et al. 2007

Pediatr Res

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Previous studies of the maturation of periodic breathing cycle duration (PCD) with postnatal age in infants have yielded conflicting results. PCD is reported to fall in term infants over the first 6 mo postnatally, whereas in preterm infants PCD is reported either not to change or to fall. Contrary to measured values, use of a theoretical respiratory control model predicts PCD should increase with postnatal age. We re-examined this issue in a longitudinal study of 17 term and 22 preterm infants. PCD decreased exponentially from birth in both groups, reaching a plateau between 4 and 6 mo of age. In preterm infants, PCD fell from a mean of 18.3 s to 9.8 s [95% confidence interval (CI) is Ϯ 3.2 s]. In term infants, PCD fell from 15.4 s to 10.1 s (95% CI is Ϯ 3.1 s). The higher PCD at birth in preterm infants, and the similar PCD value at 6 mo in the two groups, suggest a more rapid maturation of PCD in preterm infants. This study confirms that PCD declines after birth. The disagreement between our data and theoretical predictions of PCD may point to important differences between the respiratory controller of the infant and adult. E xperimental evidence is accumulating that PB in the infant, as in the adult, is caused by instability in the respiratory control system, possibly mediated by increased hypoxic stimulation of the peripheral chemoreflex feedback loop during the early postnatal period (1,2). Furthermore, math modeling studies of respiratory control based on a downscaling of adult cardiorespiratory time constants to the infant (3,4) support such a conclusion. Of interest, the theoretical model of Khoo et al. (3) predicts that the PCD should increase progressively with age from approximately 18 s at birth to an adult value in excess of 30 s.Surprisingly, most infant data contradict this model prediction, with three longitudinal studies in term infants (5-7) and one small study in preterm infants (1) reporting that PCD decreases significantly from birth to 6 mo postnatally. However, another cross-sectional study of selected long epochs of PB in a larger group of preterm infants studied just before discharge from the nursery reported that PCD showed no trend or a weakly increasing trend over the first 3 mo postnatally (8); while the results of this study could be interpreted as conforming with the predictions of the Khoo model scaled to the infant, we have argued previously that the study design may have biased the outcome (1).To resolve the issue as to whether PCD decreases or increases with postnatal age, further longitudinal studies were warranted in a larger population of term and preterm infants. Based on our earlier studies, and consistent with recent findings that the ventilatory response to CO 2 becomes brisker with age (9), we hypothesized that the reduction in PCD commencing at birth and completed by 6 mo postnatally in both term and preterm infants represents a similar adaptation to air breathing and is mediated principally by changes in the response time of the peripheral chemoreceptors. ...

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“…This accounts for variability in the PB cycle duration from 10–40 seconds. PB is usually seen in the 10–20 second range (Barrington, Finer & Wilkinson 1987, Wilkinson et al 2007, Glotzbach et al 1989), but PB has been defined as having breathing segments of up to 20 seconds duration (Barrington, Finer 1990). PB was analyzed for each infant during the entire NICU stay by shifting the family of wavelets along the apnea signal at quarter second intervals (Figure 3a–b).…”

Section: Methodsmentioning

confidence: 99%

Quantification of periodic breathing in premature infants

et al. 2015

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Background Periodic breathing (PB), regular cycles of short apneic pauses and breaths, is common in newborn infants. To characterize normal and potentially pathologic PB, we used our automated apnea detection system and developed a novel method for quantifying PB. We identified a preterm infant who died of SIDS and who, on review of her breathing pattern while in the NICU, had exaggerated PB. Methods We analyzed the chest impedance signal for short apneic pauses and developed a wavelet transform method to identify repetitive 10–40 second cycles of apnea/breathing. Clinical validation was performed to distinguish PB from apnea clusters and determine the wavelet coefficient cutoff having optimum diagnostic utility. We applied this method to analyze the chest impedance signals throughout the entire NICU stays of all 70 infants born at 32 weeks’ gestation admitted over a two-and-a-half year period. This group includes an infant who died of SIDS and her twin. Results For infants of 32 weeks’ gestation, the fraction of time spent in PB peaks 7–14 days after birth at 6.5%. During that time the infant that died of SIDS spent 40% of each day in PB and her twin spent 15% of each day in PB. Conclusions This wavelet transform method allows quantification of normal and potentially pathologic PB in NICU patients.

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Periodic Breathing Cycle Duration in Preterm Infants

Cited by 19 publications

References 16 publications

Changes in the Temporal Structure of Periodic Breathing with Postnatal Development in Preterm Infants

Changes in the Temporal Structure of Periodic Breathing with Postnatal Development in Preterm Infants

Postnatal Development of Periodic Breathing Cycle Duration in Term and Preterm Infants

Quantification of periodic breathing in premature infants

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