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Tana M, Bottoni A, Cota F, Papacci P, Di Polito A, Del Vecchio A, Vento AL, Campagnola B, Celona S, Cricenti L, Bastoni I, Tirone C, Aurilia C, Lio A, Paladini A, Nobile S, Perri A, Sbordone A, Esposito A, Fattore S, Ferrara PE, Ronconi G, Vento G. Early Respiratory Physiotherapy versus an Individualized Postural Care Program for Reducing Mechanical Ventilation in Preterm Infants: A Randomised Controlled Trial. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1761. [PMID: 38002852 PMCID: PMC10670353 DOI: 10.3390/children10111761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Tactile stimulation manoeuvres stimulate spontaneous breathing in preterm newborns. The aim of this study is to evaluate the effect of early respiratory physiotherapy on the need for mechanical ventilation during the first week of life in preterm infants with respiratory failure. METHODS This is a monocentric, randomised controlled trial. Preterm infants (gestational age ≤ 30 weeks) not intubated in the delivery room and requiring non-invasive respiratory support at birth were eligible for the study. The intervention group received early respiratory physiotherapy, while the control group received only a daily physiotherapy program (i.e., modifying the infant's posture in accordance with the patient's needs). RESULTS between October 2019 and March 2021, 133 preterm infants were studied, 68 infants in the study group and 65 in routine care. The study group showed a reduction in the need for mechanical ventilation (not statistically significant) and a statistically significant reduction in hemodynamically significant patent ductus arteriosus with respect to the control group (19/68 (28%) vs. 35/65 (54%), respectively, p = 0.03). CONCLUSIONS early respiratory physiotherapy in preterm infants requiring non-invasive respiratory support at birth is safe and has proven to be protective against haemodynamically significant PDA.
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Affiliation(s)
- Milena Tana
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Anthea Bottoni
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Francesco Cota
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Patrizia Papacci
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Alessia Di Polito
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.D.P.); (A.D.V.); (A.L.V.); (B.C.); (S.C.); (L.C.); (I.B.); (P.E.F.); (G.R.)
| | - Arianna Del Vecchio
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.D.P.); (A.D.V.); (A.L.V.); (B.C.); (S.C.); (L.C.); (I.B.); (P.E.F.); (G.R.)
| | - Anna Laura Vento
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.D.P.); (A.D.V.); (A.L.V.); (B.C.); (S.C.); (L.C.); (I.B.); (P.E.F.); (G.R.)
| | - Benedetta Campagnola
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.D.P.); (A.D.V.); (A.L.V.); (B.C.); (S.C.); (L.C.); (I.B.); (P.E.F.); (G.R.)
| | - Sefora Celona
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.D.P.); (A.D.V.); (A.L.V.); (B.C.); (S.C.); (L.C.); (I.B.); (P.E.F.); (G.R.)
| | - Laura Cricenti
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.D.P.); (A.D.V.); (A.L.V.); (B.C.); (S.C.); (L.C.); (I.B.); (P.E.F.); (G.R.)
| | - Ilaria Bastoni
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.D.P.); (A.D.V.); (A.L.V.); (B.C.); (S.C.); (L.C.); (I.B.); (P.E.F.); (G.R.)
| | - Chiara Tirone
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Claudia Aurilia
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Alessandra Lio
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Angela Paladini
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Stefano Nobile
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Alessandro Perri
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Annamaria Sbordone
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Alice Esposito
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Simona Fattore
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Paola Emilia Ferrara
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.D.P.); (A.D.V.); (A.L.V.); (B.C.); (S.C.); (L.C.); (I.B.); (P.E.F.); (G.R.)
| | - Gianpaolo Ronconi
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.D.P.); (A.D.V.); (A.L.V.); (B.C.); (S.C.); (L.C.); (I.B.); (P.E.F.); (G.R.)
| | - Giovanni Vento
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
- Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Séassau A, Munos P, Gire C, Tosello B, Carchon I. Neonatal Care Unit Interventions on Preterm Development. CHILDREN (BASEL, SWITZERLAND) 2023; 10:999. [PMID: 37371231 DOI: 10.3390/children10060999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023]
Abstract
Prematurity is becoming a real public health issue as more and more children are being born prematurely, alongside a higher prevalence of neurodevelopmental disorders. Early intervention programs in Neonatal Intensive Care Units (NICUs) correspond to these uni- or multi-sensorial solicitations aiming to prevent and detect complications in order to support the development of preterm infants. This article aims to distinguish sensory intervention programs according to the gradient of the type of solicitations, uni- or multi-modal, and according to the function of the person who performs these interventions. Uni-sensorial interventions are essentially based on proprioceptive, gustatory, or odorant solicitations. They allow, in particular, a reduction of apneas that support the vegetative states of the preterm infant. On the other hand, the benefits of multi-sensory interventions seem to have a longer-term impact. Most of them allow the support of the transition from passive to active feeding, an increase in weight, and the improvement of sleep-wake cycles. These solicitations are often practiced by caregivers, but the intervention of parents appears optimal since they are the main co-regulators of their preterm child's needs. Thus, it is necessary to co-construct and train the parents in this neonatal care.
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Affiliation(s)
- Alexia Séassau
- Centre Hospitalier du Pays d'Aix, 13100 Aix-en-Provence, France
| | | | - Catherine Gire
- Department of Neonatology, Hôpital Nord de Marseille, 13015 Marseille, France
| | - Barthélémy Tosello
- Department of Neonatology, Hôpital Nord de Marseille, 13015 Marseille, France
| | - Isabelle Carchon
- CHART Human and Artificial Cognition Laboratory at Ephe, École Pratique des Hautes Études-PSL Paris-Sciences-Lettres, 93322 Aubervilliers, France
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Anquetil M, Roche-Labarbe N, Rossi S. Tactile sensory processing as a precursor of executive attention: Toward early detection of attention impairments and neurodevelopmental disorders. WILEY INTERDISCIPLINARY REVIEWS. COGNITIVE SCIENCE 2022:e1640. [PMID: 36574728 DOI: 10.1002/wcs.1640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 09/30/2022] [Accepted: 11/21/2022] [Indexed: 12/28/2022]
Abstract
Recent studies in developmental neuroscience tend to show the existence of neural attention networks from birth. Their construction is based on the first sensory experiences that allow us to learn the patterns of the world surrounding us and preserve our limited attentional resources. Touch is the first sensory modality to develop, although it is still little studied in developmental psychology in contrast to distal modalities such as audition or vision. Atypical tactile sensory processing at an early age could predict later attention dysfunction, both of them being part of the symptomatology of neurodevelopmental disorders (NDD). We review the state of knowledge on tactile sensory processing and its links with attention, executive attention (EA) in particular, and propose that abnormal tactile sensory processing at an early age could provide markers of EA dysfunctions, contributing to the early detection of NDD. This article is categorized under: Psychology > Attention.
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Dumont V, Giovannella M, Zuba D, Clouard R, Durduran T, Guillois B, Roche-Labarbe N. Somatosensory prediction in the premature neonate brain. Dev Cogn Neurosci 2022; 57:101148. [PMID: 36027649 PMCID: PMC9428805 DOI: 10.1016/j.dcn.2022.101148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/11/2022] [Accepted: 08/18/2022] [Indexed: 11/18/2022] Open
Abstract
Sensory prediction (SP) is at the core of early cognitive development. Impaired SP may be a key to understanding the emergence of neurodevelopmental disorders, however there is little data on how and when this skill emerges. We set out to provide evidence of SP in the brain of premature neonates in the fundamental sensory modality: touch. Using Diffuse Correlation Spectroscopy, we measured blood flow changes in the somatosensory cortex of premature neonates presented with a vibrotactile stimulation-omission sequence. When ISI was fixed, participants presented a decrease in blood flow during stimulus omissions, starting when a stimulus should begin: the expectation of a certain stimulus onset induced deactivation of the somatosensory cortex. When ISI was jittered, we observed an increase in blood flow during omissions: the expectation of a likely but not certain stimulus onset induced activation of the somatosensory cortex. Our results reveal SP in the brain as early as four weeks before term, based on the temporal structure of a unimodal somatosensory stimulation, and show that SP produces opposite regulation of activity in the somatosensory cortex depending on how liable is stimulus onset. Future studies will investigate the predictive value of somatosensory prediction on neurodevelopment in this vulnerable population.
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Affiliation(s)
- Victoria Dumont
- Normandie Univ, UNICAEN, LPCN, 14000 Caen, France; Normandie Univ, UNICAEN, INSERM, COMETE, 14000 Caen, France.
| | - Martina Giovannella
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
| | - Daniel Zuba
- Normandie Univ, UNICAEN, INSERM, COMETE, 14000 Caen, France; CHU, 14000 Caen, France
| | - Régis Clouard
- Normandie Univ, UNICAEN, ENSICAEN, CNRS, GREYC, 14000 Caen, France
| | - Turgut Durduran
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), 08015 Barcelona, Spain
| | - Bernard Guillois
- Normandie Univ, UNICAEN, LPCN, 14000 Caen, France; CHU, 14000 Caen, France
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Sicard‐Cras I, Rioualen S, Pellae E, Misery L, Sizun J, Roué J. A review of the characteristics, mechanisms and clinical significance of habituation in foetuses and newborn infants. Acta Paediatr 2022; 111:245-258. [PMID: 34537978 DOI: 10.1111/apa.16115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022]
Abstract
Habituation has been a topic of interest since the early 20th century. We summarise the characteristics of habituation, the proposed habituation mechanisms, the associated cortical responses and the link between habituation and cognitive development. Behavioural and neuroimaging studies have highlighted the early sensory abilities of foetuses and newborn infants, with preterm newborn infants exhibiting decreased habituation and dishabituation capabilities that increase their environmental vulnerability. Habituation provides a foundation for the learning and cognition on which higher functions are constructed. It has been suggested that it is efficient for predicting cognitive developmental outcomes in term and preterm newborn infants.
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Affiliation(s)
- Iona Sicard‐Cras
- Department of Neonatal Medicine University Hospital of Brest Brest France
- Laboratory LIEN University of Brest Brest France
| | - Stéphane Rioualen
- Department of Neonatal Medicine University Hospital of Brest Brest France
- Laboratory LIEN University of Brest Brest France
| | - Elisabeth Pellae
- Department of Neonatal Medicine University Hospital of Brest Brest France
- Laboratory LIEN University of Brest Brest France
| | | | - Jacques Sizun
- Department of Neonatal Medicine University Hospital of Brest Brest France
- Laboratory LIEN University of Brest Brest France
| | - Jean‐Michel Roué
- Department of Neonatal Medicine University Hospital of Brest Brest France
- Laboratory LIEN University of Brest Brest France
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Zuzarte I, Sternad D, Paydarfar D. Predicting apneic events in preterm infants using cardio-respiratory and movement features. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 209:106321. [PMID: 34380078 PMCID: PMC8898595 DOI: 10.1016/j.cmpb.2021.106321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/25/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Preterm neonates are prone to episodes of apnea, bradycardia and hypoxia (ABH) that can lead to neurological morbidities or even death. There is broad interest in developing methods for real-time prediction of ABH events to inform interventions that prevent or reduce their incidence and severity. Using advances in machine learning methods, this study develops an algorithm to predict ABH events. METHODS Following previous studies showing that respiratory instabilities are closely associated with bouts of movement, we present a modeling framework that can predict ABH events using both movement and cardio-respiratory features derived from routine clinical recordings. In 10 preterm infants, movement onsets and durations were estimated with a wavelet-based algorithm that quantified artifactual distortions of the photoplethysmogram signal. For prediction, cardio-respiratory features were created from time-delayed correlations of inter-beat and inter-breath intervals with past values; movement features were derived from time-delayed correlations with inter-breath intervals. Gaussian Mixture Models and Logistic Regression were used to develop predictive models of apneic events. Performance of the models was evaluated with ROC curves. RESULTS Performance of the prediction framework (mean AUC) was 0.77 ± 0.04 for 66 ABH events on training data from 7 infants. When grouped by the severity of the associated bradycardia during the ABH event, the framework was able to predict 83% and 75% of the most severe episodes in the 7-infant training set and 3-infant test set, respectively. Notably, inclusion of movement features significantly improved the predictions compared with modeling with only cardio-respiratory signals. CONCLUSIONS Our findings suggest that recordings of movement provide important information for predicting ABH events in preterm infants, and can inform preemptive interventions designed to reduce the incidence and severity of ABH events.
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Affiliation(s)
- Ian Zuzarte
- Department of Bioengineering, Northeastern University, Boston, MA 02115, United States
| | - Dagmar Sternad
- Departments of Biology, Electrical and Computer Engineering & Physics, Northeastern University, Boston, MA 02115, United States
| | - David Paydarfar
- Department of Neurology, Dell Medical School, Austin, TX 78712, United States; Oden Institute for Computational Sciences and Engineering, The University of Texas at Austin, Austin, TX 78712, United States.
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Di Polito A, Del Vecchio A, Tana M, Papacci P, Vento AL, Campagnola B, Celona S, Cricenti L, Bastoni I, Tirone C, Lio A, Aurilia C, Bottoni A, Paladini A, Cota F, Ferrara PE, Ronconi G, Vento G. Effects of early respiratory physiotherapy on spontaneous respiratory activity of preterm infants: study protocol for a randomized controlled trial. Trials 2021; 22:492. [PMID: 34311783 PMCID: PMC8314465 DOI: 10.1186/s13063-021-05446-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Tactile maneuvers stimulating spontaneous respiratory activity in preterm infants are recommended since birth, but data on how and how often these maneuvers are applied in clinical practice are unknown. In the last years, most preterm newborns with respiratory failure are preferentially managed with non-invasive respiratory support and by stimulating spontaneous respiratory activity from the delivery room and in neonatal intensive care unit (NICU), in order to avoid the risks of intubation and prolonged mechanical ventilation. Methods Preterm infants with gestational age < 31 weeks not intubated in the delivery room and requiring non-invasive respiratory support at birth will be eligible for the study. They will be randomized and allocated to one of two treatment groups: (1) the study group infants will be subject to the technique of respiratory facilitation within the first 24 h of life, according to the reflex stimulations, by the physiotherapist. The newborn is placed in supine decubitus and a slight digital pressure is exerted on a hemithorax. The respiratory facilitation technique will be performed for about three minutes and repeated for a total of 4/6 times in sequence, three times a day until spontaneous respiratory activity is achieved; thus, no respiratory support is required; (2) the control group infants will take part exclusively in the individualized postural care program. They will perform the technique of respiratory facilitation and autogenous drainage. Objective To evaluate the efficacy of early respiratory physiotherapy in reducing the incidence of intubation and mechanical ventilation in the first week of life (primary outcome). Discussion The technique of respiratory facilitation is based on reflex stimulations, applied early to preterm infant. Slight digital pressure is exerted on a “trigger point” of each hemithorax, to stimulate the respiratory activity with subsequent increase of the ipsilateral pulmonary minute ventilation and to facilitate the contralateral pulmonary expansion. This mechanism will determine the concatenation of input to all anatomical structures in relation to the area being treated, to promote spontaneous respiratory activity and reducing work of breathing, avoiding or minimizing the use of invasive respiratory support. Trial registration UMIN-CTR Clinical Trial UMIN000036066. Registered on March 1, 2019. Protocol 1. https://www.umin.ac.jp/ctr
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Affiliation(s)
- Alessia Di Polito
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Arianna Del Vecchio
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Milena Tana
- Dipartimento Scienze della salute della donna, del bambino e di sanità pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Patrizia Papacci
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica. Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Anna Laura Vento
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Benedetta Campagnola
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Sefora Celona
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Laura Cricenti
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ilaria Bastoni
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Chiara Tirone
- Dipartimento Scienze della salute della donna, del bambino e di sanità pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandra Lio
- Dipartimento Scienze della salute della donna, del bambino e di sanità pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudia Aurilia
- Dipartimento Scienze della salute della donna, del bambino e di sanità pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anthea Bottoni
- Dipartimento Scienze della salute della donna, del bambino e di sanità pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Angela Paladini
- Dipartimento Scienze della salute della donna, del bambino e di sanità pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Cota
- Dipartimento Scienze della salute della donna, del bambino e di sanità pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Paola Emilia Ferrara
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gianpaolo Ronconi
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Vento
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica. Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy.
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Kuypers K, Martherus T, Lamberska T, Dekker J, Hooper SB, Te Pas AB. Reflexes that impact spontaneous breathing of preterm infants at birth: a narrative review. Arch Dis Child Fetal Neonatal Ed 2020; 105:675-679. [PMID: 32350064 DOI: 10.1136/archdischild-2020-318915] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/17/2020] [Accepted: 03/30/2020] [Indexed: 02/06/2023]
Abstract
Some neural circuits within infants are not fully developed at birth, especially in preterm infants. Therefore, it is unclear whether reflexes that affect breathing may or may not be activated during the neonatal stabilisation at birth. Both sensory reflexes (eg, tactile stimulation) and non-invasive ventilation (NIV) can promote spontaneous breathing at birth, but the application of NIV can also compromise breathing by inducing facial reflexes that inhibit spontaneous breathing. Applying an interface could provoke the trigeminocardiac reflex (TCR) by stimulating the trigeminal nerve resulting in apnoea and a reduction in heart rate. Similarly, airflow within the nasopharynx can elicit the TCR and/or laryngeal chemoreflex (LCR), resulting in glottal closure and ineffective ventilation, whereas providing pressure via inflations could stimulate multiple receptors that affect breathing. Stimulating the fast adapting pulmonary receptors may activate Head's paradoxical reflex to stimulate spontaneous breathing. In contrast, stimulating the slow adapting pulmonary receptors or laryngeal receptors could induce the Hering-Breuer inflation reflex or LCR, respectively, and thereby inhibit spontaneous breathing. As clinicians are most often unaware that starting primary care might affect the breathing they intend to support, this narrative review summarises the currently available evidence on (vagally mediated) reflexes that might promote or inhibit spontaneous breathing at birth.
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Affiliation(s)
- Kristel Kuypers
- Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tessa Martherus
- Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tereza Lamberska
- Neonatology, General University Hospital in Prague, Prague, Czech Republic
| | - Janneke Dekker
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Arjan B Te Pas
- Neonatology, Leiden University Medical Center, Leiden, The Netherlands
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Rigato S, Banissy MJ, Romanska A, Thomas R, van Velzen J, Bremner AJ. Cortical signatures of vicarious tactile experience in four-month-old infants. Dev Cogn Neurosci 2019; 35:75-80. [PMID: 28942240 PMCID: PMC6968956 DOI: 10.1016/j.dcn.2017.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/30/2017] [Accepted: 09/11/2017] [Indexed: 11/29/2022] Open
Abstract
The human brain recruits similar brain regions when a state is experienced (e.g., touch, pain, actions) and when that state is passively observed in other individuals. In adults, seeing other people being touched activates similar brain areas as when we experience touch ourselves. Here we show that already by four months of age, cortical responses to tactile stimulation are modulated by visual information specifying another person being touched. We recorded somatosensory evoked potentials (SEPs) in 4-month-old infants while they were presented with brief vibrotactile stimuli to the hands. At the same time that the tactile stimuli were presented the infants observed another person's hand being touched by a soft paintbrush or approached by the paintbrush which then touched the surface next to their hand. A prominent positive peak in SEPs contralateral to the site of tactile stimulation around 130 ms after the tactile stimulus onset was of a significantly larger amplitude for the "Surface" trials than for the "Hand" trials. These findings indicate that, even at four months of age, somatosensory cortex is not only involved in the personal experience of touch but can also be vicariously recruited by seeing other people being touched.
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Affiliation(s)
- Silvia Rigato
- Centre for Brain Science, Department of Psychology, University of Essex, Colchester, CO4 3SQ, UK
| | - Michael J Banissy
- Sensorimotor Development Research Unit, Department of Psychology, Goldsmiths, University of London, London, SE14 6NW, UK
| | - Aleksandra Romanska
- Sensorimotor Development Research Unit, Department of Psychology, Goldsmiths, University of London, London, SE14 6NW, UK
| | - Rhiannon Thomas
- Sensorimotor Development Research Unit, Department of Psychology, Goldsmiths, University of London, London, SE14 6NW, UK
| | - José van Velzen
- Sensorimotor Development Research Unit, Department of Psychology, Goldsmiths, University of London, London, SE14 6NW, UK
| | - Andrew J Bremner
- Sensorimotor Development Research Unit, Department of Psychology, Goldsmiths, University of London, London, SE14 6NW, UK.
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