Neonatal apnea: Pathogenesis and therapy

Kattwinkel, John

doi:10.1016/s0022-3476(77)80691-4

Cited by 125 publications

(38 citation statements)

References 41 publications

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“…The transfusions are given for replacement of blood loss from fre quent sampling [1,2], correction of anaemia [3], encouragement of growth [4] and reduc tion of apnoeic episodes [5,6], In the Neona tal Nursery of the Kandang Kerbau Hospi tal, Singapore, blood transfusion is also com monly performed mainly for replacement of blood loss especially in the first week of life, and anaemia.…”

Section: Introductionmentioning

confidence: 99%

Effect of Blood Transfusion on Acid Base, Glucose and Electrolyte Status in Very Low Birth Weight Infants

Tan

Wong²

1991

Neonatology

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The effect of citrate phosphate dextrose (CPD) blood transfusion on the acid base, glucose and electrolyte status of VLBW infants was studied in infants aged 1–7, 8–20 and > 20 days; a 4th group composed of infants > 20 days subjected to a second transfusion was also studied. All the infants remained clinically well during and after the transfusion. Only the infants in the group 1–7 days experienced a signifcant fall in ionic Ca and PO₂. No significant change in all the other parameters studied was observed. In the other groups of infants studied, the changes observed were not significant, and became less with increasing age and repeat transfusion. VLBW infants apparently tolerate CPD blood transfusion well.

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Section: Introductionmentioning

confidence: 99%

Effect of Blood Transfusion on Acid Base, Glucose and Electrolyte Status in Very Low Birth Weight Infants

Tan

Wong²

1991

Neonatology

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“…Thibeault et al [29] observed some 25 years ago that recurrent apnoeic pauses may be abolished by increasing func tional residual capacity via the application of negative extrathoracic pressure. The same ef fect can also be achieved by continuous posi tive airway pressure (CPAP) [34]. The strik ing effects of CPAP on the frequency of apnoeic/hypoxaemic episodes in preterm in fants has led to suggestions that 'the apnoea in these infants may be related to a decreasing lung volume and increasing intrapulmonary shunt' [34], i.e.…”

Section: Pathophysiology Of Apnoea and Hypoxaemia In Preterm Infantsmentioning

confidence: 99%

Epidemiology and Pathophysiology of Apnoea of Prematurity

1994

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In preterm infants, reliance on the detection of apnoeic pauses and/or bradycardia results in significant amounts of hypoxaemia remaining undetected. In addition, recordings of breathing movements and ECG do not have predictive value for subsequent sudden infant death. In recent years, the ability to continuously monitor and record arterial oxygen saturation (SaO₂) has produced important information regarding the mechanisms for respiratory events in the preterm population. Normal data on SaO₂ (Nellcor N-200) and breathing movements have been collected in 160 preterm infants. Median baseline SaO₂ during regular breathing was 99.5% (range 88.7-100) at the time of discharge from SCBU and 100% (95.3–100) at follow-up 6 weeks later. Episodic desaturations (SaO₂ < 80% for ≥4s) ranged between 0 and 355 episodes per 12-hour recording. In a study of a separate group of 16 preterm infants with recurrent cyanotic episodes of unknown cause, the total number of abnormal hypoxaemic episodes was markedly increased. These hypoxaemic episodes were associated with three breathing pattern: (i) absent breathing movements; (ii) continued breathing movements, but absent airflow, and (iii) continuous airflow and breathing movements. Thus, preterm infants with cyanotic episodes have an increased number of clinically unapparent hypoxaemic episodes, some of which occur with continued breathing and airflow. In another study of 79 patients who had been born preterm and had a history of an apparent life-threatening event, 43 (54%) had abnormal oxygenation on multichannel recordings, including 23% with clinically undetected baseline hypoxaemia. Continuous additional inspired oxygen was given to 27 patients with recorded abnormalities in oxygenation and a history of recurrent ALTE needing cardiopulmonary resuscitation: in 25, episodes stopped or markedly reduced in frequency. Home PO₂ monitoring has been undertaken in 73 patients for a median duration of 7.1 months. Recognition and treatment of abnormalities in episodic or baseline hypoxaemia may reduce the risk for recurrent cyanotic episodes or subsequent apparent life-threatening events at home. In infants with a history of such episodes, the use of additional inspired oxygen and home PO₂ monitoring are helpful in management. The finding of abnormal hypoxaemia may be relevant to the increased risk of sudden death found in preterm infants.

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“…Methylxanthines, such as theophylline, aminophylline, and caffeine, currently are used extensively in the treatment of apnea in the neonatal period (1, 6,7,10,15,17). However, little is known about potential long and short-term effects of this class of drugs on the developing brain.…”

Section: Speculationmentioning

confidence: 99%

Reduction of Cholesterol Synthesis by Methylxanthines in Cultured Glial Cells

Allan

Volpe

1979

Pediatr Res

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Summarywhether regulatory effects occur at known tissue concentrations ofMethylxanthines are shown in this study to decrease cholesterol synthesis in cultured C-6 glial cells. Aminophylline (10-3M) produced a rapid decline in cholesterol synthesis so that by 6 hr, synthesis in treated cells was less than 20% of that in untreated cells, and by 24 hr, less than 10%. Aminophylline induced parallel changes in 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase activity, the rate-limiting enzyme in cholesterol synthesis. Theophylline and caffeine produced similar effects. Thus, methyxanthines caused a specific, enzyme-mediated reduction in cholesterol synthesis in C-6 glia. In an attempt to relate the methylxanthines' effect on cultured glial cells to the developing nervous system, cholesterol synthesis was studied in the presence of 10-4M aminophylline. This represents a theophylline concentration in the culture medium that is of the same order of magnitude a s that produced in whole brain of animals administered therapeutic doses of aminophylline. Under these conditions, cholesterol synthesis was reduced to approximately 60% of control after 48 and 72 hr. SpeculationCholesterol is the major lipid constituent of myelin and other cell membranes and reduction in synthesis of this lipid could have deleterious effects. C-6 glia are models of the glial stem cell found in developing brain before myelination, e.g., human brain in the perinatal period. This study raises the question whether serious reductions in brain cholesterol synthesis occur in vivo during the treatment of neonatal apnea.

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Neonatal apnea: Pathogenesis and therapy

Cited by 125 publications

References 41 publications

Effect of Blood Transfusion on Acid Base, Glucose and Electrolyte Status in Very Low Birth Weight Infants

Effect of Blood Transfusion on Acid Base, Glucose and Electrolyte Status in Very Low Birth Weight Infants

Epidemiology and Pathophysiology of Apnoea of Prematurity

Reduction of Cholesterol Synthesis by Methylxanthines in Cultured Glial Cells

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