1738 Sudden Infant Death Syndrome (Sids) in Infants With Bronchopulmonary Dysplasia (Bpd)

Werthammer, Joseph; Brown, Elizabeth R.; Neff, Raymond K.; Taeusch, H. William

doi:10.1203/00006450-198104001-01757

Cited by 27 publications

(31 citation statements)

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“…The slow, secondary increase in HR which occurred in healthy preterms exposed to CO 2 was also largely absent in BPD; this may indicate impaired adrenal catecholamine release or altered cardiac adrenergic receptor activity caused by chronic sympathetic overactivation, both of which are complications of BPD (34 -36). A strong cardiodepressant reflex of the sort we describe is a poor prognostic sign: it could trigger or deepen asphyxial coma or prevent cardiovascular autoresuscitation and may be a factor contributing to the high SIDS rate in BPD (6,10,37).…”

Section: Discussionmentioning

confidence: 99%

Abnormal Circulatory Stress Responses of Preterm Graduates

2007

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Preterm birth and chronic lung disease may increase the risk of hypertension and cardiovascular disease in infancy and adolescence. Here we looked for evidence of early circulatory dysfunction associated with these perinatal complications. We compared infants born at term (n ϭ 12) with those born preterm with an uncomplicated neonatal course (n ϭ 12) or diagnosed with bronchopulmonary dysplasia (BPD) (n ϭ 10). We measured blood pressure (BP) (Finometer), and heart rate (HR) responses to 4 min of breathing 4% CO 2 during quiet sleep. Hypercapnia accelerated HR and increased BP of term infants. Preterm infants either (i) had an exaggerated pressor but little or no HR response to CO 2 (healthy or mild-moderate BPD) or (ii) had a diminished pressor response and accompanying decrease in HR (severe BPD). Short-term reflex cardiovascular control was consequently altered by premature birth, with potentially more serious aberrations associated with severe BPD. Most anomalies had not resolved by the time infants born preterm reached term age; some may be early signs of emerging long-term cardiovascular dysfunction. W ith the impressive increase in survival of very preterm and low birth weight infants come new challenges. Evidence already indicates that this "new generation" of children and adolescents may have accelerated disease onset later in life (1). One factor contributing to their higher risk of cardiovascular disease may be abnormal vascular and circulatory development (2-4). Cardiovascular activity is normally carefully regulated, but if some or all of the central and peripheral regulatory mechanisms involved fail to develop normally, perfusion, growth, and function may be compromised. In exceptional circumstances during infancy, persistent serious dysfunction could result in a sudden catastrophic decrease in BP and HR or prevent autoresuscitative recovery, culminating in sudden infant death syndrome (SIDS) (5,6). In other cases, dysfunction may be relatively benign, although there may still be side effects with adverse consequences of their own.We know relatively little about how BP and HR control develops, and the potentially adverse effects of fetal and perinatal stress. A better understanding of these issues could lead to new therapies or strategies to prevent neonatal complications and improve long-term outcome. In the study described here, we looked for evidence that development of neonatal circulatory control is altered by common perinatal complications (7). We studied three different groups of newborn infants: those born normally at term, those born preterm but otherwise healthy, and infants born very preterm suffering from chronic lung disease (BPD). Infants with BPD are at particularly high risk of long-term cardiovascular complications and SIDS (8 -10). We compared BP and HR responses of these infants to a routine physiologic stress (breathing a low concentration of CO 2 for several minutes) commonly used to unmask autonomic anomalies (11). Normally, acute exposure to CO 2 increases BP and HR ...

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Section: Discussionmentioning

confidence: 99%

Abnormal Circulatory Stress Responses of Preterm Graduates

2007

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“…Results from several studies do suggest that home oxygen therapy may lead to a decrease in the frequency of sudden infant death syndrome [4,5], a decrease in the frequency of intermittent hypoxaemia [6,7], an increase in weight gain [8] and a reduction in the length of time spent in hospital [9]. However, there has yet been no randomised controlled trial on the effectiveness of home oxygen therapy in infants.…”

Section: Introductionmentioning

confidence: 99%

Prescription of Home Oxygen Therapy to Infants in Germany

Peter

Poets²

2001

Neonatology

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There is no consensus on home oxygen therapy in infancy. We hypothesised that this might lead to considerable variability in the practice of prescribing home oxygen to infants. To assess this variability, a structured questionnaire was sent to all departments of Paediatrics in Germany (n = 380). Response rate was 92% (n = 349). Indications were mostly (86%) based on long-term recordings of pulse oximeter saturation (S_PO₂). There was, however, a wide range (85–94%, mean 90%) of S_PO₂-values below which oxygen therapy was considered indicated. Hospitals more experienced with this therapy tended to prescribe oxygen at S_PO₂ values closer to the physiological range. Similarly, S_PO₂ values aimed for during therapy ranged from 86 to 100%, with hospitals prescribing home oxygen more frequently aiming for higher values. These differences would argue for concentrating home oxygen therapy to centers with the largest experience.

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“…Sin embargo, es recomendable emplear monitores de apnea o cardiorrespiratorios en el domicilio, ya que los pacientes con DBF tienen 7 veces mas riesgo de muerte subita que sujetos control 22 . En esta serie se empleo monitor de apnea en un solo caso y no ocurrieron situaciones de apnea grave o de amenaza frustra de muerte subita.…”

Section: Discusionunclassified

Oxigenoterapia domiciliaria en niños con displasia broncopulmonar

Beca

Torres

Sfeir

et al. 1990

Rev. chil. pediatr.

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Eight babies with severe bronchopulmonary dysplasia (BPD) were discharged from a private hospital at Santiago, Chile, on a program that provided oxygen therapy at home. Mean gestational age was 27 ± 2 weeks and mean birth weight was 1,181 ±353 g. Discharge was decided after stabilization of arterial POs orO 2 Sat, PC02 <50 mmHg and adequate weight gain. Prior to discharge parents were trained in O 2 administration and cardiopulmonary resucitatk>n. Oxygen was given at home for a mean of 71 days (range 7 to 339). There were no complications secondary to oxygen therapy. At follow up in only two cases additional hospitalizations were needed, in both instances because of intercurrent respiratory infections. Weight gain between 3 m and 50 tn percentile were seen in all cases. Oxygen therapy at home appears to be a good alternative in the treatment of infants with BPD, and it reduces significantly hospital stay and costs. Both optimal family conditions and adequate support at home are needed. (Key words: bronchopulmonary dysplasia, oxygen therapy at home, on a program for oxygen therapy at home.) La displasia broncopulmonar (DBF) o enfer-nacional, en la cual, si bien ha habido escasas medad pulmonar cronica es una afeccion propia publicaciones 4 ' 6 , los casos han aumentado en de los recie"n nacidos de bajo peso, sometidos a niimero en casi todas las unidades de neonatoloventHacion mecanica, atribuida a multiples gia en los ultimos anos. Los niflos mas graves factores; entre los que destacan la inmadu-requieren largas hospitalizaciones, debidas a la rez pulmonar, el barotrauma, causado por los prolongada dependencia de oxi'geno, que puede respiradores y el efecto toxico del oxi'geno en durar varies meses, como a las frecuentes enferel pulmon. Su incidencia aumenta, a pesar de medades intercurrentes. los multiples esfuerzos de prevention, a medida Con el objeto de evaluar la factibilidad, venque aumenta la sobrevida de recien nacidos de tajas y eventuates complicaciones de la oxigenomenor peso y menor edad gestacional 1 ' 3 . Esta terapia en domicilio como parte del tratamiento ha sido la experiencia tanto extranjera como de la DBF, se estudio retrospectivamente ungrupo de niflos afectados que fueron dados de alta con oxigenoterapia en su domicilio con el fin de 1. Servicio de Neonatologia, Clinica Alemana. abreviar la ho sp realization y favorecer la vida 2. Kinesiologo.familiar.

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1738 Sudden Infant Death Syndrome (Sids) in Infants With Bronchopulmonary Dysplasia (Bpd)

Cited by 27 publications

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Abnormal Circulatory Stress Responses of Preterm Graduates

Abnormal Circulatory Stress Responses of Preterm Graduates

Prescription of Home Oxygen Therapy to Infants in Germany

Oxigenoterapia domiciliaria en niños con displasia broncopulmonar

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