Blood Pressure and Heart Rate Patterns During Sleep Are Altered in Preterm-Born Infants: Implications for Sudden Infant Death Syndrome

Witcombe, Nicole B.; Yiallourou, Stephanie; Walker, Adrian M.; Horne, Rosemary Sylvia Claire

doi:10.1542/peds.2008-1400

Cited by 49 publications

(36 citation statements)

References 38 publications

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“…4 SIDS peaks in incidence at 2 to 4 months of age 5,6 and is believed to involve an uncompensated cardiovascular event presumed to occur during sleep, in conjunction with failure of the life-saving arousal response. [7][8][9][10][11] Preterm infants exhibit immature cardio-respiratory control, which persists past term-equivalent age, 12 is related to gestational age (GA) at birth, 13,14 and may contribute to their heightened risk for SIDS. 15 Prone sleeping is a major risk factor for SIDS, particularly among infants born preterm.…”

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confidence: 99%

Cerebral Oxygenation in Preterm Infants

et al. 2014

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BACKGROUND AND OBJECTIVE: Prone sleeping is a major risk factor for sudden infant death syndrome (SIDS) and preterm infants are at significantly increased risk. In term infants, prone sleeping is associated with reduced mean arterial pressure (MAP) and cerebral tissue oxygenation index (TOI). However, little is known about the effects of sleeping position on TOI and MAP in preterm infants. We aimed to examine TOI and MAP in preterm infants after term-equivalent age, during the period of greatest SIDS risk. METHODS: Thirty-five preterm and 17 term infants underwent daytime polysomnography, including measurement of TOI (NIRO-200 spectrophotometer, Hamamatsu Photonics KK, Japan) and MAP (Finapress Medical Systems, Amsterdam, Netherlands) at 2 to 4 weeks, 2 to 3 months, and 5 to 6 months postterm age. Infants slept prone and supine in active and quiet sleep. The effects of sleep state and position were determined by using 2-way repeated measures analysis of variance and of preterm birth by using 2-way analysis of variance. RESULTS: In preterm infants, TOI was significantly lower when prone compared with supine in both sleep states at all ages (P < .05). Notably, TOI was significantly lower in preterm compared with term infants at 2 to 4 weeks, in both positions (P < .05), and at 2 to 3 months when prone (P < .001), in both sleep states. MAP was also lower in preterm infants in the prone position at 2 to 3 months (P < .01). CONCLUSIONS: Cerebral oxygenation is reduced in the prone position in preterm infants and is lower compared with age-matched term infants, predominantly in the prone position when MAP is also reduced. This may contribute to their increased SIDS risk.

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Cerebral Oxygenation in Preterm Infants

et al. 2014

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“…[73][74][75] Preterm infants have lower blood pressure and cerebral oxygenation than age-matched term infants, most marked when in the prone position. 76,77 These observations provide evidence for the increased risk of sudden death in infants sleeping prone, and at critical developmental periods.…”

Section: Environmental (Extrinsic) Factorsmentioning

confidence: 77%

Sudden Unexpected Death in Fetal Life Through Early Childhood

2016

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In March 2015, the Eunice Kennedy Shriver National Institute of Child Health and Human Development held a workshop entitled “Sudden Unexpected Death in Fetal Life Through Early Childhood: New Opportunities.” Its objective was to advance efforts to understand and ultimately prevent sudden deaths in early life, by considering their pathogenesis as a potential continuum with some commonalities in biological origins or pathways. A second objective of this meeting was to highlight current issues surrounding the classification of sudden infant death syndrome (SIDS), and the implications of variations in the use of the term “SIDS” in forensic practice, and pediatric care and research. The proceedings reflected the most current knowledge and understanding of the origins and biology of vulnerability to sudden unexpected death, and its environmental triggers. Participants were encouraged to consider the application of new technologies and “omics” approaches to accelerate research. The major advances in delineating the intrinsic vulnerabilities to sudden death in early life have come from epidemiologic, neural, cardiac, metabolic, genetic, and physiologic research, with some commonalities among cases of unexplained stillbirth, SIDS, and sudden unexplained death in childhood observed. It was emphasized that investigations of sudden unexpected death are inconsistent, varying by jurisdiction, as are the education, certification practices, and experience of death certifiers. In addition, there is no practical consensus on the use of “SIDS” as a determination in cause of death. Major clinical, forensic, and scientific areas are identified for future research.

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“…SIDS is believed to involve an uncompensated cardiovascular event during sleep, in conjunction with failure of the life-saving arousal response (5,6). We have previously shown that preterm infants exhibit immature control of heart rate (HR) and blood pressure which persists for 6 mo past term-equivalent age and have suggested that this may underlie their increased risk for SIDS (7)(8)(9). Furthermore, we have recently reported that blood pressure and cerebral oxygenation are reduced in preterm compared with age-matched term infants, and this is most marked when they sleep prone (10), the major risk factor for SIDS.…”

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Dummy/pacifier use in preterm infants increases blood pressure and improves heart rate control

et al. 2015

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Background: Preterm infants are at increased risk of sudden infant death syndrome (SIDS). Use of a dummy/ pacifier is thought to be protective against SIDS; accordingly, we assessed the effects of dummy/pacifier use on blood pressure, cerebral oxygenation, and heart rate control over the first 6 mo of life after term corrected age (CA) when SIDS risk is greatest. Methods: Thirty-five preterm infants were studied longitudinally at 2-4 wk, 2-3 mo, and 5-6 mo CA. Cardiac control was assessed from spectral indices of heart rate variability (HRV) in the low frequency (LF) and the high frequency (HF) range, and the ratio of HF/LF indicating sympathovagal balance was calculated. results: Overall, at 2-3 mo, mean arterial pressure was significantly higher in the supine position in dummy/pacifier users in both quiet sleep (70 ± 2 vs. 60 ± 2 mm Hg; P < 0.05) and active sleep (74 ± 3 vs. 69 ± 2 mm Hg; P < 0.05). Dummy/pacifier users had higher LF HRV and LF/HF ratio and lower HF HRV. conclusion: Dummy/pacifier use increased blood pressure during sleep, at the age of greatest SIDS risk. Overall, LF HRV was elevated and HF HRV reduced in dummy/pacifier users, suggesting that dummy use alters cardiac control in preterm infants.

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Blood Pressure and Heart Rate Patterns During Sleep Are Altered in Preterm-Born Infants: Implications for Sudden Infant Death Syndrome

Cited by 49 publications

References 38 publications

Cerebral Oxygenation in Preterm Infants

Cerebral Oxygenation in Preterm Infants

Sudden Unexpected Death in Fetal Life Through Early Childhood

Dummy/pacifier use in preterm infants increases blood pressure and improves heart rate control

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