Absence of Ventilatory Responses to Alternating Breaths of Mild Hypoxia and Air in Infants Who Have Had Bronchopulmonary Dysplasia: Implications for the Risk of Sudden Infant Death

Calder, Nicole; Williams, Bridget A; Smyth, John; Boon, A W; Kumar, Prem; Hanson, Mark A.

doi:10.1203/00006450-199406000-00011

Cited by 90 publications

(38 citation statements)

References 12 publications

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“…(22,23) Alternatively, the association between pre-eclampsia and SDB could be mediated by fetal hypoxia. (24)(25)(26)(27)(28)(29)(30),(31) Pre-eclampsia may cause chronic fetal hypoxia directly via maternal vascular insufficiency with subsequent reduction of fetal oxygen delivery due to placental insufficiency, or may be acting as a marker for intermittent maternal hypoxia associated with maternal SDB. The association of childhood SDB with mild but not severe pre-eclampsia is of particular interest because it is consistent with proposed differences in the biology of mild versus severe pre-eclampsia.…”

Section: Discussionmentioning

confidence: 99%

Prenatal and Neonatal Risk Factors for Sleep Disordered Breathing in School-Aged Children Born Preterm

Hibbs

Johnson

Rosen

et al. 2008

The Journal of Pediatrics

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Objectives-Previously published data from the Cleveland Children's Sleep and Health Study (CCSHS) demonstrated that preterm infants are especially vulnerable both to sleep disordered breathing (SDB) and its neurocognitive sequelae at age 8-11 years. In this analysis, we aimed to identify the components of the neonatal medical history associated with childhood SDB among children born prematurely.Study design-This analysis focuses on the 383 children in the population-based CCSHS cohort who were born <37 weeks gestational age and who had technically acceptable sleep studies performed at ages 8-11 years (92% of all preterm children). Logistic regression was used to evaluate the associations between candidate perinatal and neonatal risk factors and the presence of childhood SDB by sleep study.Results-Twenty-eight preterm children (7.3%) met the definition for SDB at age 8-11 years. Having a single mother and mild maternal pre-eclampsia were strongly associated with SDB in unadjusted and race-adjusted models. Unadjusted analyses also identified xanthine use and CPR and/ or intubation in the delivery room as potential risk-factors for SDB. We did not find a significant link between traditional markers of severity of neonatal illness --such as gestational age, birth weight, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), or duration of ventilation --and childhood SDB at school age.Conclusions-These results represent a first step in identifying prenatal and neonatal characteristics which place preterm infants at higher risk for childhood SDB. The strong association between mild pre-eclampsia and childhood SDB underscores the importance of research aimed at understanding in utero risk factors for neurorespiratory development. Corresponding Author: Anna Maria Hibbs, MD, MSCE, Division of Neonatology, Rainbow Babies & Children's Hospital, 11100 Euclid Avenue, Suite 3100, Cleveland, email: annamaria.hibbs@case.edu. Edited by AJ and WFB Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. (1) Furthermore, the association between sleep disordered breathing (SDB) and childhood cognitive impairment is stronger in preterm than term infants. (8) The mechanisms by which prematurity predisposes children to SDB are unknown. The association may be mediated by altered development of the lungs, airway, or nervous system. In this analysis, we aimed to identify the components of the prenatal and neonatal medical history associated with SDB occurring in children in the CCSHS studied at ages 8-11 years who had been born prematurely. NIH Public Access METHODSThe CCSHS is a po...

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Section: Discussionmentioning

confidence: 99%

Prenatal and Neonatal Risk Factors for Sleep Disordered Breathing in School-Aged Children Born Preterm

Hibbs

Johnson

Rosen

et al. 2008

The Journal of Pediatrics

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“…These data suggest that our subject may have altered chemoreflexes. Indeed, it is known that patients with BPD have blunted and abnormal chemoreflex responses (Garg et al, 1988;Calder et al, 1994).…”

Section: Figmentioning

confidence: 99%

Excessive Gas Exchange Impairment during Exercise in A Subject with A History of Bronchopulmonary Dysplasia And High Altitude Pulmonary Edema

Lovering¹,

Romer²,

Haverkamp³

et al. 2007

High Altitude Medicine & Biology

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A 27-year-old male subject (V(O2 max)), 92% predicted) with a history of bronchopulmonary dysplasia (BPD) and a clinically documented case of high altitude pulmonary edema (HAPE) was examined at rest and during exercise. Pulmonary function testing revealed a normal forced vital capacity (FVC, 98.1% predicted) and diffusion capacity for carbon monoxide (D(L(CO)), 91.2% predicted), but significant airway obstruction at rest [forced expiratory volume in 1 sec (FEV(1)), 66.5% predicted; forced expiratory flow at 50% of vital capacity (FEF(50)), 34.3% predicted; and FEV(1) /FVC 56.5%] that was not reversible with an inhaled bronchodilator. Gas exchange worsened from rest to exercise, with the alveolar to arterial P(O2) difference (AaD(O2)) increasing from 0 at rest to 41 mmHg at maximal normoxic exercise (VO(2) = 41.4 mL/kg/min) and from 11 to 31 mmHg at maximal hypoxic exercise (VO(2) = 21.9 mL/kg/min). Arterial P(O2) decreased to 67.8 and 29.9 mmHg at maximal normoxic and hypoxic exercise, respectively. These data indicate that our subject with a history of BPD is prone to a greater degree of exercise-induced arterial hypoxemia for a given VO(2) and F(I(O2)) than healthy age-matched controls, which may increase the subject's susceptibility to high altitude illness.

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“…Weaker peripheral chemoresponses have been reported in infants with resolving bronchopulmonary dysplasia, a group at increased risk for sudden infant death [8].…”

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confidence: 98%

Peripheral chemoresponses of infants measured by a minimally invasive method utilizing two-breath alternations in Fl,02

Thomas¹,

Poole²,

McArdle³

et al. 1996

Eur Respir J

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The aim of this study was to develop a minimally invasive and reliable method for measuring peripheral chemoresponsiveness to oxygen in infants, and to establish baseline data from normal infants at 12 weeks of age. Two-breath alternations in fractional inspired oxygen (FI,O 2 ), switching between 0.42 to 0.00 were given for 2 min periods via a face mask (held close to the face but without contact) to 18 healthy infants during quiet sleep. End-tidal oxygen concentrations alternated between 21 and 11%. Instantaneous minute ventilation (V ' 'E) and its components tidal volume (VT), respiratory frequency (fR) inspiratory and expiratory times (tI and tE), inspiratory flow (VT/tI), and inspiratory duty cycle (tI/ttot) were measured by respiratory inductance plethysmography. Two-breath alternations in each of the ventilatory components were matched with the corresponding alternating end-tidal oxygen record and compared with contiguous pre-and post-test data obtained in control periods of air breathing.Alternations in all ventilatory components except f R changed significantly during FI,O 2 alternations; VT 26%, tE -8%, VT/tI 18%, tI/ttot 11% and V ' 'E 28% of baseline values. Within and between infant variances are reported for the individual components of ventilation. Differences among infants were best detected by alternations in V ' 'E; within infant variance 76, between infant variance 171.We conclude that the test described is a safe, reliable and relatively easily applied method of measuring peripheral chemoresponsiveness, which is suitable for clinical application in infancy.

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Absence of Ventilatory Responses to Alternating Breaths of Mild Hypoxia and Air in Infants Who Have Had Bronchopulmonary Dysplasia: Implications for the Risk of Sudden Infant Death

Cited by 90 publications

References 12 publications

Prenatal and Neonatal Risk Factors for Sleep Disordered Breathing in School-Aged Children Born Preterm

Prenatal and Neonatal Risk Factors for Sleep Disordered Breathing in School-Aged Children Born Preterm

Excessive Gas Exchange Impairment during Exercise in A Subject with A History of Bronchopulmonary Dysplasia And High Altitude Pulmonary Edema

Peripheral chemoresponses of infants measured by a minimally invasive method utilizing two-breath alternations in Fl,02

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