Apnea of Prematurity

Martin, Richard J.; Wilson, Christopher G.

doi:10.1002/cphy.c100021

Cited by 43 publications

(31 citation statements)

References 98 publications

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“…These findings suggest that maturation advances the regulation of UES, esophageal body peristalsis, and LES functions during sleep. Brain stem maturation is the most likely contributing factor to the regulation of observed sensory-motor interaction patterns, with similar observations reported through maturation of the central pattern generator and the respiratory rhythm regulation apparatus (4,5,22,26,35). We speculate that appropriate regulation of esophageal peristalsis and sphincteric functions protect the proximal aerodigestive tract against retrograde threats such as GER events during sleep.…”

Section: Aerodigestive Sensitivity and Electro-cortical Arousals: Effsupporting

confidence: 83%

Maturation of upstream and downstream esophageal reflexes in human premature neonates: the role of sleep and awake states

Jadcherla

Chan

Fernández³

et al. 2013

American Journal of Physiology-Gastrointestinal and Liver Physi

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Jadcherla SR, Chan CY, Fernandez S, Splaingard M. Maturation of upstream and downstream esophageal reflexes in human premature neonates: the role of sleep and awake states. Am J Physiol Gastrointest Liver Physiol 305: G649 -G658, 2013. First published September 5, 2013 doi:10.1152/ajpgi.00002.2013.-We tested the hypothesis that the sensory-motor characteristics of aerodigestive reflexes are dependent on stimulus type and volumes, sleep or awake states, and maturation. Thirteen neonates were studied at 33.6 Ϯ 0.5 wk (time 1) and 37.3 Ϯ 0.5 wk (time 2) postmenstrual age using multimodal provocative esophageal manometry concurrent with video polysomnography. Effects of graded volumes (399 infusions at time 1, 430 infusions at time 2) of midesophageal stimulation with air, water, and apple juice on the sensory thresholds and recruitment frequency of upper esophageal sphincter (UES), esophageal body, and lower esophageal sphincter (LES) reflexes were investigated during sleep and awake states. Sensory thresholds for aerodigestive reflexes between maturational stages were similar. Increased frequency recruitment of UES contractile reflex, LES relaxation reflex, and peristaltic reflexes were noted at time 2 (all, P Ͻ 0.05). Graded stimulusresponse relationships were evident at time 1 and time 2 during awake and sleep states (P Ͻ 0.05). Secondary peristalsis vs. esophagodeglutition response proportions during sleep at time 1 vs. time 2 (P ϭ 0.001) and awake vs. sleep at time 2 (P ϭ 0.02) were distinct. We concluded that sensory-motor effects of esophageal mechanosensitivity, osmosensitivity, and chemosensitivity are advanced in sleep with maturation. Sleep further modulates the frequency recruitment and the type of aerodigestive reflexes.sleep; upper esophageal sphincter; lower esophageal sphincter; peristaltic reflex SLEEP IS BOTH A CRUCIAL AND VULNERABLE physiological state for the developing infant. Although it is essential for conservation of energy and growth, the aerodigestive tract also becomes increasingly susceptible to both retrograde and anterograde aspiration during periods of sleep. Aerodigestive adaptation to these provocations must be maintained; however, the effects of such esophageal provocation during sleep are unclear. Compromise of aerodigestive functions may have serious consequences such as apparent life-threatening events (ALTE) or sudden infant death syndrome (SIDS) (1). It is common practice for infants who have experienced such events to undergo evaluation for esophageal and sleep pathology, as there is often a presumed causal connection between ALTE, SIDS, and aerodigestive pathology with respect to aspiration. These infants are often treated empirically for gastroesophageal reflux disease (GERD) and associated sleep disturbance, using treatments such as caffeine, positional changes, modifications of milk type or density, changes in feeding volumes or feeding methods, medical therapy, or even surgical intervention (2, 6, 25, 36). These treatments have aerodigestive consequences, may be expens...

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Section: Aerodigestive Sensitivity and Electro-cortical Arousals: Effsupporting

confidence: 83%

Maturation of upstream and downstream esophageal reflexes in human premature neonates: the role of sleep and awake states

Jadcherla

Chan

Fernández³

et al. 2013

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…Airway protection through glottic closure is phylogenetically the oldest and the most important function of the laryngeal adductor muscles that is critical for animal survival (Hoh 2010). Repetitive breath-holding due to involuntary glottic closure is a major cause of life-threatening apnea in preterm infants (te Pas et al 2009; Martin and Wilson 2012) or post-anesthesia laryngospasm (Hampson-Evans et al 2008) and a cardinal symptom of Rett syndrome (Stettner et al 2007; Weese-Mayer et al 2006). Additionally, aspiration pneumonia due to impaired glottic closure during swallowing is a major cause of death in many neurological disorders such as Alzheimer’s disease, intoxication, dysphagia, and stroke (Pitts 2013).…”

Section: Discussionmentioning

confidence: 99%

Multiscale fingerprinting of neuronal functional connectivity

2014

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SUMMARY Current cellular-based connectomics approaches aim to delineate the functional or structural organizations of mammalian brain circuits through neuronal activity mapping and/or axonal tracing. To discern possible connectivity between functionally identified neurons in widely distributed brain circuits, reliable and efficient network-based approaches of cross-registering or cross-correlating such functional-structural data are essential. Here, a novel cross-correlation approach that exploits multiple timing-specific, response-specific and cell-specific neuronal characteristics as coincident fingerprint markers at the systems, network and cellular levels is proposed. Application of this multiscale temporal-cellular coincident fingerprinting assay to the respiratory central pattern generator network in rats revealed a descending excitatory pathway with characteristic activity pattern and projecting from a distinct neuronal population in pons to its counterparts in medulla that control the post-inspiratory phase of the respiratory rhythm important for normal breathing, airway protection and respiratory-vocalization coordination. This enabling neurotracing approach may prove valuable for functional connectivity mapping of other brain circuits.

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“…Central apnea, defined as cessation of breathing for ≥ 20 seconds, is considered a manifestation of developmental immaturity of respiratory control mediated by the brainstem in preterm neonates and disordered respiratory control in term and late-preterm infants with neuropathology. 9,10 To understand how hyperbilirubinemia might lead to central apnea requires an understanding of the physiology of respiratory control in neonates.…”

Section: Physiology Of Respiratory Controlmentioning

confidence: 99%

Apnea in acute bilirubin encephalopathy

Amin

Bhutani

Watchko

2014

Seminars in Perinatology

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Central apnea, defined as cessation of breathing for ≥ 20 seconds, is frequent in premature infants born < 34 weeks gestation but uncommon among healthy late preterm (340/7 – 366/7 weeks gestation) and term (≥ 37 weeks gestation) infants where it is usually a clinical manifestation of a neurological or metabolic problem. There is growing evidence that marked unconjugated hyperbilirubinemia is associated with central apnea in neonates. This paper explores the reported association between acute bilirubin encephalopathy and symptomatic apneic events in newborns and the possible mechanisms involved in the pathogenesis of this phenomenon. The prevalence of symptomatic apneic events in reports of acute bilirubin encephalopathy suggests this clinical finding should be considered a sign of bilirubin neurotoxicity.

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Apnea of Prematurity

Cited by 43 publications

References 98 publications

Maturation of upstream and downstream esophageal reflexes in human premature neonates: the role of sleep and awake states

Maturation of upstream and downstream esophageal reflexes in human premature neonates: the role of sleep and awake states

Multiscale fingerprinting of neuronal functional connectivity

Apnea in acute bilirubin encephalopathy

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