Organization of Physiological Parameters in Normal and Neurologically Abnormal Infants

Hf, Prechtl; Weinmann, H; Akiyama, Yoshio

doi:10.1055/s-0028-1091867

Cited by 81 publications

(37 citation statements)

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“…Sleep occurs in the newborn for 70% to 80% of the time 33,34,53 and is the normal response after birth. Recent reports addressed the issue of the quiet sleep during the first day after birth and interpreted this state as a newborn adaptive response to the stress of the birth.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Skin-to-Skin Contact (Kangaroo Care) Shortly After Birth on the Neurobehavioral Responses of the Term Newborn: A Randomized, Controlled Trial

2004

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Background. The method of skin-to-skin contact (kangaroo care [KC]) has shown physiologic, cognitive, and emotional gains for preterm infants; however, KC has not been studied adequately in term newborns. Aims. To evaluate the effect of KC, used shortly after delivery, on the neurobehavioral responses of the healthy newborn. Study Design. A randomized, controlled trial using a table of random numbers. After consent, the mothers were assigned to 1 of 2 groups: KC shortly after delivery or a no-treatment standard care (control group). Subjects. Included were 47 healthy mother-infant pairs. KC began at 15 to 20 minutes after delivery and lasted for 1 hour. Control infants and KC infants were brought to the nursery 15 to 20 and 75 to 80 minutes after birth, respectively. Results. During a 1-hour-long observation, starting at 4 hours postnatally, the KC infants slept longer, were mostly in a quiet sleep state, exhibited more flexor movements and postures, and showed less extensor movements. Conclusions. KC seems to influence state organization and motor system modulation of the newborn infant shortly after delivery. The significance of our findings for supportive transition from the womb to the extrauterine environment is discussed. Medical and nursing staff may be well advised to provide this kind of care shortly after birth.

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Section: Discussionmentioning

confidence: 99%

The Effect of Skin-to-Skin Contact (Kangaroo Care) Shortly After Birth on the Neurobehavioral Responses of the Term Newborn: A Randomized, Controlled Trial

2004

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“…Early studies of respiration in infants are characterized by a lack of systematic attention to sleep states (3,4,15) (18) were among the first to establish conclusively the significant state modulation of respiratory rate and variability in infants up to 8 days of age. During the QS state, Prechtl et al (18) reported breathing rates between 34 and 40/min, whereas during AS, the range increased to 42-60/min.…”

Section: Speculationmentioning

confidence: 99%

Polygraphic Studies of Normal Infants during the First Six Months of Life. II. Respiratory Rate and Variability as a Function of State

et al. 1978

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SummaryThis study examined spontaneous respiratory rate and variability as a function of age and sleep state in eight normal fullterm infants. Each infant was admitted at 5 0 0 PM to the sleep laboratory for 12-hr monitoring sessions during the first week of life and at 1, 2, 3, 4, and 6 months of age. Both sleep and cardiopulmonary variables were recorded. A Beckman pCO, monitor sampled expired gas through a miniature cannula taped under the infant's nostrils. Peaks and troughs of breaths were measured by a computer peak sensing program. Median respiratory rates and interquartile ranges of breath intervals for each minute were determined. Each minute was coded as quiet sleep (QS), active sleep (AS), waking (AW), and indeterminate state (IN). Respiratory rates and variability were highest during the first week of life. They declined during the next 2 months and began to level out at 3 months of age (Table 3).The state-relationship was not homogeneous at all ages. Respiratory rates and variability during wakefulness were always higher than those during sleep states. The strongest relation between respiration and sleep states was found between birth and 3 months of age. QS values were uniformly low, and those of AS and IN minutes were intermediate between AW and QS. SpeculationRespiration rates and variability decreased linearly between birth and three months of age. The differences between the developmental course of respiratory rates and variability between 1 and 3 months reported here and cardiac rates and variability previously reported in the same infants suggest a difference in the central nervous system modulation of these systems.Early studies of respiration in infants are characterized by a lack of systematic attention to sleep states (3,4,15) (18) were among the first to establish conclusively the significant state modulation of respiratory rate and variability in infants up to 8 days of age. During the QS state, Prechtl et al. (18) reported breathing rates between 34 and 40/min, whereas during AS, the range increased to 42-60/min. Breath to breath variability was found to be less during QS than during AS. These studies are restricted to the newborn period.Another variable found to influence baseline respiratory rates is the feeding or prandial cycle. Ashton and Connolly (2) found higher breathing rates during the time period immediately after feeding as compared to the remainder of the interfeeding time in all sleep states. Again, these studies were restricted to newborn infants. The lack of systematic studies in older infants has precluded assessment of the theoretical and clinical significance of early developmental respiratory patterns. A long term continuous monitoring paradigm is particularly suited for evaluation of the relative effects of state and feeding, as well as the emergence of a circadian modulation. Such normative data are essential for subsequent identification of abnormal breathing patterns.The present report is the second in a series of papers which will describe polygraphic measureme...

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“…The presence or absence of gross body movements, facial expressions, eye movements and vocalizations were recorded at 10-s intervals on the chart during the study period. These observations were used to define the sleep state as either active sleep or quiet sleep using standard behavioral classification criteria (12)(13)(14). Although the presence of indeterminant sleep was recognized as a separate entity it occupied only a short portion of the monitoring period and was included in active sleep.…”

Section: Study Groupmentioning

confidence: 99%

Changes in the Temporal Structure of Periodic Breathing with Postnatal Development in Preterm Infants

et al. 1995

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The progressive decrease in the periodic cycle duration (PCD) of periodic breathing with postnatal age in term infants has been previously reported by a number of authors and is thought to be associated with peripheral chemoreceptor maturation. We hypothesized that a similar decrease should be observed in preterm infants. Therefore, in this study we measured the changes in PCD with postnatal age in a small group of preterm ( n = 4) infants followed longitudinally (36 afternoon nap studies) over the first 6 mo postnatally. PCD declined in these infants from 17.1 ? 3.3 s (mean -t-2 SD) at 9 d to 9.8 +-3.2 s (mean I 2 SD) at 105 d. The regression slope was -0.072 s/d. Beyond 105 d there was no change in PCD up to 6 mo postnatally. We found no significant difference between active and quiet sleep. These results are similar to results previously published in term infants but apparently contradict recent data on a group of preterm infants. Possible reasons for this discrepancy are discussed. By examining long epochs of periodic breathing in these infants we also identified characteristic changes in PCD and VIA ratio, defined as the duration of the ventilatory period divided by the duration of the apneic interval. VIA ratio fell from the start of an epoch from 1.21 2 0.08 (mean + SEM) to a minimum of 0.62 2 0.03 and then increased again to 0.8 -C 0.05 at the end of the epoch. We conclude that important maturational changes occu~ in the neonatal respiratory control system during the first 6 mo postnatally and that these changes are reflected in a fall in PCD of periodic breathing over this period. We also conclude that the characteristic changes which occur in VIA ratio and PCD are consistent with a role for chemical stimuli in the genesis of periodic breathing. (Pediatr Res 38: 533-538, 1995) Abbreviations SIDS, sudden infant death syndrome VIA, ratio of the duration of ventilation to the duration of apnea in one cycle of periodic breathing To, start time of a long epoch of periodic breathing Tmi,, time from To at which VIA ratio reaches its minimum value T,,,, end time of a long epoch of periodic breathing PCD, periodic breathing cycle duration A PCD, change in PCD during long epochs PNA, postnatal age PNA,,, postnatal age at which PCD ceases to decrease Sao,, arterial oxygen saturation ASao,, deviation between the mean Sao, and the peak or trough of the oscillation in Sao, during periodic breathing Periodic breathing has been studied extensively in both preterm and term infants. These studies have been aimed primarily at elucidating the causes of this type of breathing pattern in neonates and establishing the incidence during the first months of life (1,2).Much of the incentive for these studies came from earlier clinical observations that long apneas were often preceded by periodic breathing in preterm infants (3), although this finding has been disputed more recently (4). Also, a high incidence of periodic breathing has been reported in apparent life-threatening events and SIDS sibling infants when compared with ag...

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Organization of Physiological Parameters in Normal and Neurologically Abnormal Infants

Cited by 81 publications

References 0 publications

The Effect of Skin-to-Skin Contact (Kangaroo Care) Shortly After Birth on the Neurobehavioral Responses of the Term Newborn: A Randomized, Controlled Trial

The Effect of Skin-to-Skin Contact (Kangaroo Care) Shortly After Birth on the Neurobehavioral Responses of the Term Newborn: A Randomized, Controlled Trial

Polygraphic Studies of Normal Infants during the First Six Months of Life. II. Respiratory Rate and Variability as a Function of State

Changes in the Temporal Structure of Periodic Breathing with Postnatal Development in Preterm Infants

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