Relation between apnoea duration and type and neurological status of preterm infants.

Abstract

SUMMARY The incidence, duration, and type of apnoea were determined in 28 preterm infants born at 27 to 34 weeks' gestation, using polygraphic records of abdominal breathing movements and nasal airflow. Of the 1520 episodes of apnoea of 10 or more seconds duration, 1002 (66%) lasted 10 to 14 seconds, 311 (20%) lasted 15 to 20 seconds, and 207 (14%) lasted more than 20 seconds. Overall, 69% were central in type, 20% were mixed, and 11% were purely obstructive. With increasing duration of apnoea, the proportion of episodes of central apnoea decreased (69 to 29%) while that of mixed apnoea increased (20 to 60%). Eight infants had obstructive apnoea of more than 20 seconds duration. When they were compared with the 10 infants of similar gestational age and birthweight who had central or mixed apnoea, they had a higher incidence of intraventricular haemorrhage, hydrocephalus, positive pressure ventilation via an endotracheal tube, and abnormal neurological development during the first year of life.

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

“…might be neu tralized. Rapid changes in cerebral perfusion with fluctuations in blood pressure have been suggested to exacerbate or even cause cerebral lesions in the vulnerable germinal matrix of the neonatal brain [13,14], Two earlier inves tigations reported that obstructive apnea is more common with IVH and abnormal neu rological development [15,16], However, as there was no account for the timing of the hemorrhages, cause and effect could be con fused in these studies. It is possible that these infants had IVH leading to apnea rather than apnea of prematurity itself.…”

“…We are also able to sup port the concept that decreasing SaCH does correlate with the duration of the apnea re gardless of type [22]. We documented mixed events as being the longest in duration as pre viously described [ 15], According to our results, monitoring of heart rate is only appropriate to detect changes in cerebral hemodynamics during purely central apnea, whereas in events with upper airway obstruction, where impact on cerebral blood volume is greatest, alterations in tHb are not reflected in heart rate. It should be considered that it is not the apneic episode itself, but its impact on cerebral perfusion that is relevant for a normal development of the neonatal brain.…”

Factors Influencing Apnea and Bradycardia of Prematurity – Implications for Neurodevelopment

“…The alterations of cerebral oxygenation and perfusion during ABP [8][9][10] might be detrimental to the normal cerebral development of preterm infants. However, the long-term consequences of ABP have rarely been reported, and many previous studies describe populations very different from those treated today [11][12][13][14][15] . The first aim of this study was to provide a more recent, detailed description of the temporal evolution of ABP in a population of VLBW infants, and to characterize neonatal risk factors predisposing towards more severe or prolonged courses of ABP.…”

Ventriculoperitoneal Shunt Obstruction Presenting as Apnea and Bradycardia

“…Additionally, apnea was an identified risk factor for hydrocephalus in preterm infants studied with polysomnography [3]. We believe that this represents the first report of shunt obstruction detected by cardiorespiratory monitoring.…”