Apnées du prématuré : données récentes

Moriette, G; Lescure, Sandra; Ayoubi, Mayass El; López, E.

doi:10.1016/j.arcped.2009.09.016

Cited by 17 publications

(7 citation statements)

References 12 publications

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“…Resolution of apnea and establishment of a normal respiratory pattern is a major developmental milestone for many premature infants. The most widely used definition of apnea of prematurity (AOP) specifies a pause of breathing for more than 15–20 s, or accompanied by oxygen desaturation (SpO 2 ≤ 80% for ≥4 s) and bradycardia (heart rate < 2/3 of baseline for ≥4 s), in infants born less than 37 weeks of gestation [55]. …”

Section: Introductionmentioning

confidence: 99%

Apnea of prematurity: from cause to treatment

2011

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Apnea of prematurity (AOP) is a common problem affecting premature infants, likely secondary to a “physiologic” immaturity of respiratory control that may be exacerbated by neonatal disease. These include altered ventilatory responses to hypoxia, hypercapnia, and altered sleep states, while the roles of gastroesophageal reflux and anemia remain controversial. Standard clinical management of the obstructive subtype of AOP includes prone positioning and continuous positive or nasal intermittent positive pressure ventilation to prevent pharyngeal collapse and alveolar atelectasis, while methylxanthine therapy is a mainstay of treatment of central apnea by stimulating the central nervous system and respiratory muscle function. Other therapies, including kangaroo care, red blood cell transfusions, and CO2 inhalation, require further study. The physiology and pathophysiology behind AOP are discussed, including the laryngeal chemoreflex and sensitivity to inhibitory neurotransmitters, as are the mechanisms by which different therapies may work and the potential long-term neurodevelopmental consequences of AOP and its treatment.

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Section: Introductionmentioning

confidence: 99%

Apnea of prematurity: from cause to treatment

2011

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“…Breathing pauses, counted as episodes >3–5 sec in duration (short pauses), and >5 sec in duration (long pauses), the number of IH episodes, determined as the number of events in which O 2 saturation fell below 90%, 88%, and 85% for at least 5 sec, and the number of bradycardia episodes were evaluated. A number of AOP studies define significant bradycardia as any decline in heart rate to two-thirds of baseline OR a drop of 30–33% from baseline [ 25 – 27 ]. Since the baseline heart rate for our study population was between 150–165 bpm, we chose 100 and 110 bpm as the threshold for bradycardia.…”

Section: Methodsmentioning

confidence: 99%

Neuromodulation of Limb Proprioceptive Afferents Decreases Apnea of Prematurity and Accompanying Intermittent Hypoxia and Bradycardia

et al. 2016

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BackgroundApnea of Prematurity (AOP) is common, affecting the majority of infants born at <34 weeks gestational age. Apnea and periodic breathing are accompanied by intermittent hypoxia (IH). Animal and human studies demonstrate that IH exposure contributes to multiple pathologies, including retinopathy of prematurity (ROP), injury to sympathetic ganglia regulating cardiovascular action, impaired pancreatic islet cell and bone development, cerebellar injury, and neurodevelopmental disabilities. Current standard of care for AOP/IH includes prone positioning, positive pressure ventilation, and methylxanthine therapy; these interventions are inadequate, and not optimal for early development.ObjectiveThe objective is to support breathing in premature infants by using a simple, non-invasive vibratory device placed over limb proprioceptor fibers, an intervention using the principle that limb movements trigger reflexive facilitation of breathing.MethodsPremature infants (23–34 wks gestational age), with clinical evidence of AOP/IH episodes were enrolled 1 week after birth. Caffeine treatment was not a reason for exclusion. Small vibration devices were placed on one hand and one foot and activated in 6 hour ON/OFF sequences for a total of 24 hours. Heart rate, respiratory rate, oxygen saturation (SpO2), and breathing pauses were continuously collected.ResultsFewer respiratory pauses occurred during vibration periods, relative to baseline (p<0.005). Significantly fewer SpO2 declines occurred with vibration (p<0.05), relative to control periods. Significantly fewer bradycardic events occurred during vibration periods, relative to no vibration periods (p<0.05).ConclusionsIn premature neonates, limb proprioceptive stimulation, simulating limb movement, reduces breathing pauses and IH episodes, and lowers the number of bradycardic events that accompany aberrant breathing episodes. This low-cost neuromodulatory procedure has the potential to provide a non-invasive intervention to reduce apnea, bradycardia and intermittent hypoxia in premature neonates.Trial RegistrationClinicalTrials.gov NCT02641249

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“…Mixed apnea is the most frequent type of long apnea among preterm infants [19]. A mixed apnea usually starts as a central apnea and ends as an obstructive apnea.…”

Section: Simulation Of Apnea-bradycardia Eventsmentioning

confidence: 99%

Model-Based Analysis of Apnea-Bradycardias in Newborns

Duport¹,

Rolle²,

Guerrero³

et al. 2022

Computing in Cardiology Conference (CinC)

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In preterm infants, recurrent episodes of apnea, bradycardia and severe intermittent hypoxia are mainly related to cardiorespiratory immaturity. These episodes are associated with major risks during the first weeks of life. Cardiorespiratory data consisting of a continuous 12 hours recording of transthoracic impedance and ECG signals were acquired in 18 preterm neonates. 106 isolated apnea events (>10 sec) were manually annotated from the database, of which 19 apneas with bradycardia. A systemlevel physiological model of cardio-respiratory interactions in the newborn is proposed and used to reproduce simulations of mixed apneas with and without bradycardia, by modifying the functional residual capacity. A first qualitative comparison between the simulations and the clinical data shows a close match between the experimental and simulated heart rate series during apnea with bradycardia (RMSE 4.96 bpm) and without (RMSE 2.02 bpm).

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Apnées du prématuré : données récentes

Cited by 17 publications

References 12 publications

Apnea of prematurity: from cause to treatment

Apnea of prematurity: from cause to treatment

Neuromodulation of Limb Proprioceptive Afferents Decreases Apnea of Prematurity and Accompanying Intermittent Hypoxia and Bradycardia

Model-Based Analysis of Apnea-Bradycardias in Newborns

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