Impact of Central, Obstructive and Mixed Apnea on Cerebral Hemodynamics in Preterm Infants

Jenni, Oskar G.; Wolf, Martin; Hengartner, Markus; Siebenthal, Kurt von; Keel, M.; Bucher, H. U.

doi:10.1159/000244353

Cited by 37 publications

(28 citation statements)

References 12 publications

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“…Although some groups have studied the influence of apnea of prematurity on cerebral oxygenation [14,15,16,17,18,19,20,21,22,24,25], only two of them have focused on different types of events [18,22] and neither of the two reported cerebral StO 2 , but instead reported hemoglobin concentrations as a measure of cerebral blood volume. …”

Section: Discussionmentioning

confidence: 99%

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Cerebral Oxygenation during Intermittent Hypoxemia and Bradycardia in Preterm Infants

et al. 2014

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Background: Episodes of hypoxemia and bradycardia frequently occur with apnea of prematurity in preterm infants. Little is known about the impact of different event types on the brain. Objectives: To describe the influence of hypoxemia and bradycardia, either isolated or in combination, on cerebral oxygenation. Methods: In 16 preterm infants with intermittent hypoxemia and/or bradycardia, cerebral tissue oxygen saturation (StO₂, as measured by near-infrared spectroscopy), heart rate and pulse oximetric saturation (SpO₂) were recorded simultaneously for 16 h. Events were classified as isolated bradycardia (type 1), isolated hypoxemia (type 2) or combined (simultaneous, type 3; bradycardia first, type 4; hypoxemia first, type 5). Primary outcome was a score representing the area below baseline for cerebral StO₂ desaturation during an event. Secondary outcomes were duration and depth of cerebral desaturation. Results: Patients had a median (range) gestational age of 25.9 (22.6-30.4) weeks and a postnatal age of 32.5 (7-58) days. The median (quartiles) number of events was 49 (34-58). Isolated hypoxemias were the most frequent events (24; 9-36) and isolated bradycardias the least common (0; 0-1). Cerebral StO₂ baseline was not different between event types. Cerebral desaturation score, duration of event and depth of cerebral desaturation were smallest for isolated bradycardias and largest for combined events, especially for those starting with hypoxemia followed by bradycardia. Regardless of event type, 12/16 infants maintained cerebral StO₂ >60% despite severe SpO₂ desaturations. Conclusions: Isolated bradycardias had the lowest impact on cerebral desaturation, and combined events had the highest. Most infants preserved cerebral oxygenation >60% during events.

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Section: Discussionmentioning

confidence: 99%

“…However, little is known about the impact of different event types on cerebral StO 2 . Published studies focused on one type only or did not differentiate between event types [14,15,16,17,18,19,20,21,22]. …”

Section: Introductionmentioning

confidence: 99%

Cerebral Oxygenation during Intermittent Hypoxemia and Bradycardia in Preterm Infants

et al. 2014

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“…23 Furthermore, even short-lasting central, obstructive, or mixed apneic events may affect cerebral hemodynamics in preterm infants. 24 Although the ultimate long-term adverse consequences of such bradycardic episodes and regional brain flow fluctuations are still unclear, the number of bradycardic events tended to decrease after the initiation of low-flow SupOx.…”

Section: Discussionmentioning

confidence: 99%

Effect of Supplemental Oxygen on Sleep Architecture and Cardiorespiratory Events in Preterm Infants

et al. 2002

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Asymptomatic preterm infants exhibit frequent and potentially clinically adverse cardiorespiratory events when assessed in the sleep laboratory. Administration of SupOx to these infants is associated with an increase in the overall duration and percentage TST spent in quiet sleep with reciprocal changes in active sleep. In addition, improvement in respiratory stability is observed with the use of low-flow SupOx, as evidenced by a decrease in apnea, periodic breathing, and bradycardia, without adverse effects on alveolar ventilation.

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“…When breathing pauses become prolonged or when breathing periods between sucks are inadequate or interrupted, infant physiologic regulation may be exceeded with resultant oxygen desaturations [1][2][3][4][5][6][7]. Recurrent episodes of hypoxemia, such as may occur through repeated feedings throughout the preterm infant's day, may affect cardiac and pulmonary function, impair preterm infant growth and development of oral feeding skills, and may alter cerebral blood volume and oxygenation which have been implicated in neonatal cerebral injury [2,[8][9][10][11][12][13]. Very little is known about the occurrence of feeding hypoxemia near the time of discharge when preterm infants are fed by their mothers, who typically anticipate being the primary feeder postdischarge [14].…”

Section: Introductionmentioning

confidence: 99%

Occurrence of oxygen desaturation events during preterm infant bottle feeding near discharge

Thoyre

Carlson

2003

Early Human Development

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Aims-The purpose of this study was to examine the occurrence, severity, pattern, and moderators of oxygen desaturation during preterm infant bottle feeding near the time of discharge from the neonatal intensive care unit (NICU) when fed by mothers.Study design-Twenty-two very low birthweight (VLBW) infants [birthweight 1155 ± 293 g, gestational age (GA) 28.1 ± 2.0, postconceptional age (PCA) 36.5 ± 1.6 weeks] were videotaped being bottle-fed by their mothers. Most infants (86%) were discharged within 6 days of the study. Oxygen saturation was continuously monitored and infant feeding behaviors were coded. Oxygen desaturation events (SpO 2 < 90%) were identified and analyzed.Results-Infants averaged 10.8 events during feeding (range 1-28, S.D. 8.9) and spent, on average, 20% of their feeding time (range 0-70%, S.D. 17.98%) with oxygen levels below 90%. One hundred forty of the desaturation events (59%) were classified as mild (SpO 2 85-89), 47 events (20%) were classified as moderate (SpO 2 81-84), and 51 events (21%) were classified as severe (SpO 2 ≤ 80). Events were evenly distributed across infants' feeding time. Receiving supplemental oxygen, beginning the feeding with a higher baseline SpO 2 , and being of older PCA predicted lower percentage of feeding time with SpO 2 below 90% (R 2 = 0.57). Receiving supplemental oxygen and beginning the feeding with a higher baseline SpO 2 predicted less number of desaturation events during the feeding (R 2 = 0.44). Despite similar baseline SpO 2 levels, infants who were on supplemental oxygen had 50% less oxygen desaturation events and spent 33% less time with SpO 2 less than 90%.Conclusion-VLBW infants continue to have desaturation events during feeding when fed by their mothers near the time of discharge. Further research is needed to understand the effect of hypoxemia on the preterm infant's development of oral feeding skills, to study the effects of supplemental oxygen during feeding, and to further develop interventions to minimize desaturation during feeding.

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Impact of Central, Obstructive and Mixed Apnea on Cerebral Hemodynamics in Preterm Infants

Cited by 37 publications

References 12 publications

Cerebral Oxygenation during Intermittent Hypoxemia and Bradycardia in Preterm Infants

Cerebral Oxygenation during Intermittent Hypoxemia and Bradycardia in Preterm Infants

Effect of Supplemental Oxygen on Sleep Architecture and Cardiorespiratory Events in Preterm Infants

Occurrence of oxygen desaturation events during preterm infant bottle feeding near discharge

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