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Patural H, Pichot V, Roche F, Giraud A. Why, when and how to assess autonomic nervous system maturation in neonatal care units: A practical overview. Neurophysiol Clin 2023; 53:102855. [PMID: 36965238 DOI: 10.1016/j.neucli.2023.102855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/05/2023] [Indexed: 03/27/2023] Open
Abstract
The evaluation of the autonomic reactivity of newborns by heart rate variability (HRV) analysis is a simple and essential aid to identifying pathological situations of dysautonomia. Thanks to this relatively simple and reproducible analytic tool, the pediatrician can identify and target children at high risk of life-threatening events, i.e., those with insufficient intrinsic capacity for cardiorespiratory self-regulation, who should benefit from close cardiorespiratory monitoring. Different mathematical algorithms integrate delayed or real-time variations in the length of the RR interval to better understand the state of autonomic maturation of the newborn. HRV analysis, as a non-invasive tool for assessing autonomic balance, is essential to assess the functioning of the autonomic nervous system and, more specifically, parasympathetic/sympathetic balance. Despite many recognized diagnostic and therapeutic implications, its application to neonatal medicine is not yet well understood.
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Affiliation(s)
- Hugues Patural
- Neonatal and Pediatric Intensive Care Unit, Centre Hospitalier Universitaire de Saint-Étienne, F-42023, Saint-Étienne, France; Université Jean Monnet Saint-Étienne, INSERM, SAINBIOSE U1059, F-42023, Saint-Étienne, France.
| | - Vincent Pichot
- Université Jean Monnet Saint-Étienne, INSERM, SAINBIOSE U1059, F-42023, Saint-Étienne, France
| | - Frédéric Roche
- Université Jean Monnet Saint-Étienne, INSERM, SAINBIOSE U1059, F-42023, Saint-Étienne, France
| | - Antoine Giraud
- Neonatal and Pediatric Intensive Care Unit, Centre Hospitalier Universitaire de Saint-Étienne, F-42023, Saint-Étienne, France; Université Jean Monnet Saint-Étienne, INSERM, SAINBIOSE U1059, F-42023, Saint-Étienne, France
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Barbosa DF, Bana LF, Michel MCB, Meira E Cruz M, Zancanella E, Machado Júnior AJ. Rapid maxillary expansion in pediatric patients with obstructive sleep apnea: an umbrella review. Braz J Otorhinolaryngol 2023; 89:494-502. [PMID: 36894478 DOI: 10.1016/j.bjorl.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 12/26/2022] [Accepted: 02/10/2023] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVE To compare polysomnographic parameters with others from the literature in order to provide more accurate information about Rapid Maxillary Expansion (RME) for treating Obstructive Sleep Apnea (OSA) in children, through raising the question: Is RME a good option for treating OSA in children? Prevention of mouth breathing during children's growth remains a challenge with significant clinical consequences. In addition, OSA induces anatomofunctional changes during the critical period of craniofacial growth and development. METHODS The Medline, PubMed, EMBASE, CINAHL, Web of Science, SciELO and Scopus electronic databases were searched up to February 2021 for systematic reviews with meta-analysis in the English language. Among 40 studies on RME for treating OSA in children, we selected seven in which polysomnographic measurements of the Apnea-Hypopnea Index (AHI) had been made. Data were extracted and examined in order to clarify whether any consistent evidence exists for indicating RME as a treatment for OSA in children. RESULTS We found no consistent evidence favoring RME for long-term treatment of OSA in children. All the studies presented considerable heterogeneity due to variability of age and length of follow-up. CONCLUSION Through this umbrella review, the need for methodologically better studies on RME is supported. Moreover, it can be considered that RME is not recommended for treating OSA in children. Further studies and more evidence identifying early signs of OSA are necessary in order to achieve consistent healthcare practice.
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Affiliation(s)
- Denise Fernandes Barbosa
- Universidade de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Laura Fernandes Bana
- Universidade de Campinas (FOP-UNICAMP), Faculdade de Odontologia, Departamento de Morfologia, Piracicaba, SP, Brazil
| | | | - Miguel Meira E Cruz
- Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Unidade de Sono, Lisboa, Portugal
| | - Edilson Zancanella
- Universidade de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil.
| | - Almiro José Machado Júnior
- Universidade de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
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Mayerl CJ, Gould FDH, Adjerid K, Edmonds C, German RZ. The Pathway from Anatomy and Physiology to Diagnosis: A Developmental Perspective on Swallowing and Dysphagia. Dysphagia 2023; 38:33-41. [PMID: 35441265 PMCID: PMC9579268 DOI: 10.1007/s00455-022-10449-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 04/04/2022] [Indexed: 01/29/2023]
Abstract
Dysphagia results from diverse and distinct etiologies. The pathway from anatomy and physiology to clinical diagnosis is complex and hierarchical. Our approach in this paper is to show the linkages from the underlying anatomy and physiology to the clinical presentation. In particular, the terms performance, function, behavior, and physiology are often used interchangeably, which we argue is an obstacle to clear discussion of mechanism of pathophysiology. We use examples from pediatric populations to highlight the importance of understanding anatomy and physiology to inform clinical practice. We first discuss the importance of understanding anatomy in the context of physiology and performance. We then use preterm infants and swallow-breathe coordination as examples to explicate the hierarchical nature of physiology and its impact on performance. We also highlight where the holes in our knowledge lie, with the ultimate endpoint of providing a framework that could enhance our ability to design interventions to help patients. Clarifying these terms, and the roles they play in the biology of dysphagia will help both the researchers studying the problems as well as the clinicians applying the results of those studies.
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Affiliation(s)
- C J Mayerl
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA
| | - F D H Gould
- Department of Cell Biology and Neuroscience, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - K Adjerid
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA
| | - C Edmonds
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA
| | - R Z German
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA.
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Camporesi A, Diotto V, Zoia E, Rotta S, Tarantino F, Eccher LMG, Calcaterra V, Pelizzo G, Gemma M. Postoperative apnea after pyloromyotomy for infantile hypertrophic pyloric stenosis. WORLD JOURNAL OF PEDIATRIC SURGERY 2022; 5:e000391. [DOI: 10.1136/wjps-2021-000391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/20/2022] [Indexed: 11/04/2022] Open
Abstract
ObjectiveInfantile hypertrophic pyloric stenosis (IHPS), which causes gastric outlet obstruction and hypochloremic hypokalemic metabolic alkalosis, could pose a risk of postoperative apnea in patients. The aim of this study is to evaluate the incidence of postoperative apnea in babies admitted to a tertiary-level pediatric surgical center in Milano, Italy with diagnosis of IHPS in 2010–2019. The secondary objective is to evaluate the risk factors for postoperative apnea.MethodsThis is a single-center, retrospective, observational cohort study. All patients admitted to our institution with diagnosis of IHPS during the study period were enrolled. Demographic and surgical variables, along with blood gas parameters, were obtained from the population. Postoperative apnea was defined as a respiratory pause longer than 15 s or a respiratory pause lasting less than 15 s, but associated with either bradycardia (heart rate <120 per minute), desaturation (SatO2 <90%), cyanosis, or hypotonia. Occurrence was obtained from nursing charts and was recorded as a no/yes dichotomous variable.ResultsOf 122 patients, 12 (9.84%) experienced apnea and 110 (90.16%) did not. Using univariate analysis, we found that only postoperative hemoglobin was significantly different between the groups (p=0.03). No significant multivariable model was better than this univariate model for prediction of apnea.ConclusionsPostoperative anemia, possibly due to hemodilution, increased the risk of postoperative apnea. It could be hypothesized that anemia can be added as another apnea-contributing factor in a population at risk due to metabolic changes.
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Patural H, Franco P, Pichot V, Giraud A. Heart Rate Variability Analysis to Evaluate Autonomic Nervous System Maturation in Neonates: An Expert Opinion. Front Pediatr 2022; 10:860145. [PMID: 35529337 PMCID: PMC9069105 DOI: 10.3389/fped.2022.860145] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/15/2022] [Indexed: 02/03/2023] Open
Abstract
While heart rate variability (HRV) is a relevant non-invasive tool to assess the autonomic nervous system (ANS) functioning with recognized diagnostic and therapeutic implications, the lack of knowledge on its interest in neonatal medicine is certain. This review aims to briefly describe the algorithms used to decompose variations in the length of the RR interval and better understand the physiological autonomic maturation data of the newborn. Assessing newborns' autonomous reactivity can identify dysautonomia situations and discriminate children with a high risk of life-threatening events, which should benefit from cardiorespiratory monitoring at home. Targeted monitoring of HRV should provide an objective reflection of the newborn's intrinsic capacity for cardiorespiratory self-regulation.
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Affiliation(s)
- Hugues Patural
- Neonatal and Pediatric Intensive Care Department, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
- INSERM, U1059, SAINBIOSE, Université de Lyon, Université Jean-Monnet, Saint-Étienne, France
| | - Patricia Franco
- Sleep and Neurological Functional Explorations, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Vincent Pichot
- INSERM, U1059, SAINBIOSE, Université de Lyon, Université Jean-Monnet, Saint-Étienne, France
| | - Antoine Giraud
- Neonatal and Pediatric Intensive Care Department, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
- INSERM, U1059, SAINBIOSE, Université de Lyon, Université Jean-Monnet, Saint-Étienne, France
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6
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Wiegandt FC, Biegger D, Fast JF, Matusiak G, Mazela J, Ortmaier T, Doll T, Dietzel A, Bohnhorst B, Pohlmann G. Detection of Breathing Movements of Preterm Neonates by Recording Their Abdominal Movements with a Time-of-Flight Camera. Pharmaceutics 2021; 13:pharmaceutics13050721. [PMID: 34068978 PMCID: PMC8156597 DOI: 10.3390/pharmaceutics13050721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/20/2022] Open
Abstract
In order to deliver an aerosolized drug in a breath-triggered manner, the initiation of the patient’s inspiration needs to be detected. The best-known systems monitoring breathing patterns are based on flow sensors. However, due to their large dead space volume, flow sensors are not advisable for monitoring the breathing of (preterm) neonates. Newly-developed respiratory sensors, especially when contact-based (invasive), can be tested on (preterm) neonates only with great effort due to clinical and ethical hurdles. Therefore, a physiological model is highly desirable to validate these sensors. For developing such a system, abdominal movement data of (preterm) neonates are required. We recorded time sequences of five preterm neonates’ abdominal movements with a time-of-flight camera and successfully extracted various breathing patterns and respiratory parameters. Several characteristic breathing patterns, such as forced breathing, sighing, apnea and crying, were identified from the movement data. Respiratory parameters, such as duration of inspiration and expiration, as well as respiratory rate and breathing movement over time, were also extracted. This work demonstrated that respiratory parameters of preterm neonates can be determined without contact. Therefore, such a system can be used for breathing detection to provide a trigger signal for breath-triggered drug release systems. Furthermore, based on the recorded data, a physiological abdominal movement model of preterm neonates can now be developed.
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Affiliation(s)
- Felix C. Wiegandt
- Division of Translational Biomedical Engineering, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, 30625 Hannover, Germany; (D.B.); (T.D.)
- Correspondence: (F.C.W.); (G.P.); Tel.: +49-511-5350-287 (F.C.W.); +49-511-5350-116 (G.P.)
| | - David Biegger
- Division of Translational Biomedical Engineering, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, 30625 Hannover, Germany; (D.B.); (T.D.)
| | - Jacob F. Fast
- Institute of Mechatronic Systems, Leibniz Universität Hannover, 30823 Garbsen, Germany; (J.F.F.); (T.O.)
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, 30625 Hannover, Germany
| | - Grzegorz Matusiak
- Division of Infectious Diseases, Department of Neonatology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (G.M.); (J.M.)
| | - Jan Mazela
- Division of Infectious Diseases, Department of Neonatology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (G.M.); (J.M.)
| | - Tobias Ortmaier
- Institute of Mechatronic Systems, Leibniz Universität Hannover, 30823 Garbsen, Germany; (J.F.F.); (T.O.)
| | - Theodor Doll
- Division of Translational Biomedical Engineering, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, 30625 Hannover, Germany; (D.B.); (T.D.)
- Department of Otorhinolaryngology, Hannover Medical School, 30625 Hannover, Germany
| | - Andreas Dietzel
- Institute of Microtechnology, Technische Universität Braunschweig, 38124 Braunschweig, Germany;
| | - Bettina Bohnhorst
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, 30625 Hannover, Germany;
| | - Gerhard Pohlmann
- Division of Translational Biomedical Engineering, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, 30625 Hannover, Germany; (D.B.); (T.D.)
- Correspondence: (F.C.W.); (G.P.); Tel.: +49-511-5350-287 (F.C.W.); +49-511-5350-116 (G.P.)
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Taxini CL, Marques DA, Bícego KC, Gargaglioni LH. A5 noradrenergic neurons and breathing control in neonate rats. Pflugers Arch 2021; 473:859-872. [PMID: 33855632 DOI: 10.1007/s00424-021-02550-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/16/2021] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
The pontine A5 noradrenergic group contributes to the maturation of the respiratory system before birth in rats. These neurons are connected to the neural network responsible for respiratory rhythmogenesis. In the present study, we investigated the participation of A5 noradrenergic neurons in neonates (P7-8 and P14-15) in the control of ventilation during hypoxia and hypercapnia in in vivo experiments using conjugated saporin anti-dopamine beta-hydroxylase (DβH-SAP) to specifically ablate noradrenergic neurons. Thus, DβH-SAP (420 ng/μL) or saporin (SAP, control) was injected into the A5 region of neonatal male Wistar rats. Hypoxia reduced respiratory variability in control animals; however, A5 lesion prevented this effect in P7-8 rats. Our data suggest that noradrenergic neurons of the A5 region in neonate rats do not participate in the control of ventilation under baseline and hypercapnic conditions, but exert an inhibitory modulation on breathing variability under hypoxic challenge in early life (P7-8).
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Affiliation(s)
- Camila L Taxini
- Department of Morphology and Animal Physiology - FCAV, São Paulo State University (UNESP), Via de acesso Paulo Donato Castellane s/n, Jaboticabal, SP, 14870-900, Brazil
| | - Danuzia A Marques
- Department of Pediatrics, Centre de Recherche de L'Institut Universitaire de Cardiologie Et de Pneumologie de Québec, Université Laval, Québec, G1V 4G5, Canada
| | - Kênia C Bícego
- Department of Morphology and Animal Physiology - FCAV, São Paulo State University (UNESP), Via de acesso Paulo Donato Castellane s/n, Jaboticabal, SP, 14870-900, Brazil
| | - Luciane H Gargaglioni
- Department of Morphology and Animal Physiology - FCAV, São Paulo State University (UNESP), Via de acesso Paulo Donato Castellane s/n, Jaboticabal, SP, 14870-900, Brazil.
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Arfuso F, Giannetto C, Giudice E, Assenza A, Piccione G. Daily dynamic changes of blood acid-base status and vital parameters in lambs and goat kids over the first seven days after birth. Small Rumin Res 2021. [DOI: 10.1016/j.smallrumres.2021.106340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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9
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Sanchez JB, Jadcherla SR. Gastroesophageal Reflux Disease in Neonates: Facts and Figures. Neoreviews 2021; 22:e104-e117. [PMID: 33526640 DOI: 10.1542/neo.22-2-e104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Jenny Bellodas Sanchez
- Innovative Neonatal and Infant Feeding Disorders Research Program, Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH.,Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Sudarshan R Jadcherla
- Innovative Neonatal and Infant Feeding Disorders Research Program, Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH.,Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
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10
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Affiliation(s)
- James D Tutor
- Program in Pediatric Pulmonary Medicine, University of Tennessee Health Science Center, LeBonheur Children's Hospital, and St. Jude Children's Research Hospital, Memphis, TN
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11
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van der Heijden ME, Zoghbi HY. Development of the brainstem respiratory circuit. WILEY INTERDISCIPLINARY REVIEWS-DEVELOPMENTAL BIOLOGY 2019; 9:e366. [PMID: 31816185 DOI: 10.1002/wdev.366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 02/01/2023]
Abstract
The respiratory circuit is comprised of over a dozen functionally and anatomically segregated brainstem nuclei that work together to control respiratory rhythms. These respiratory rhythms emerge prenatally but only acquire vital importance at birth, which is the first time the respiratory circuit faces the sole responsibility for O2 /CO2 homeostasis. Hence, the respiratory circuit has little room for trial-and-error-dependent fine tuning and relies on a detailed genetic blueprint for development. This blueprint is provided by transcription factors that have specific spatiotemporal expression patterns along the rostral-caudal or dorsal-ventral axis of the developing brainstem, in proliferating precursor cells and postmitotic neurons. Studying these transcription factors in mice has provided key insights into the functional segregation of respiratory control and the vital importance of specific respiratory nuclei. Many studies converge on just two respiratory nuclei that each have rhythmogenic properties during the prenatal period: the preBötzinger complex (preBötC) and retrotrapezoid nucleus/parafacial nucleus (RTN/pF). Here, we discuss the transcriptional regulation that guides the development of these nuclei. We also summarize evidence showing that normal preBötC development is necessary for neonatal survival, and that neither the preBötC nor the RTN/pF alone is sufficient to sustain normal postnatal respiratory rhythms. Last, we highlight several studies that use intersectional genetics to assess the necessity of transcription factors only in subregions of their expression domain. These studies independently demonstrate that lack of RTN/pF neurons weakens the respiratory circuit, yet these neurons are not necessary for neonatal survival because developmentally related populations can compensate for abnormal RTN/pF function at birth. This article is categorized under: Nervous System Development > Vertebrates: Regional Development.
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Affiliation(s)
- Meike E van der Heijden
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas.,Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, Texas
| | - Huda Y Zoghbi
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas.,Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, Texas.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Howard Hughes Medical Institute, Baylor College of Medicine, Houston, Texas
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12
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Quinlan C, Piccione J, Kim JY, Beck SE, Brooks L, Chandy-Patel R, Escobar E, Afolabi-Brown O. The role of polysomnography in tracheostomy decannulation of children with bronchopulmonary dysplasia. Pediatr Pulmonol 2019; 54:1676-1683. [PMID: 31424180 DOI: 10.1002/ppul.24474] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/23/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with bronchopulmonary dysplasia (BPD) may require tracheostomy for long-term mechanical ventilation. Polysomnography (PSG) may predict successful decannulation in children, however it is unclear how this success compares with children without a PSG. To better evaluate this role, we compared decannulation outcomes between tracheostomy-dependent children with BPD who underwent PSG before decannulation to those who did not. METHODS This is a retrospective cohort study between 1 January 2007 and 1 June 2017 of tracheostomy-dependent children with BPD who were clinically considered for decannulation. Patient demographics, PSG results, and medical comorbidities were abstracted from medical records and compared between groups. Decannulation outcomes were compared between children with BPD who underwent PSG before decannulation and those who did not. RESULTS One hundred twenty-five patients with BPD were considered for tracheostomy decannulation. Forty-six (37%) had a pre-decannulation PSG while 79 (63%) did not. Nineteen (41%) patients did not undergo decannulation within 6 months of the PSG. One (3%) patient with pre-decannulation PSG failed decannulation. Four (5%) patients without pre-decannulation PSG failed decannulation. Nineteen patients with PSG and no decannulation had significantly higher obstructive apnea-hypopnea index (OAHI) (13.62 vs 2.68 events per hour, P = 0.004), higher end-tidal CO 2 max (52.84 vs 48.03 mm Hg, P = 0.035), and were older at PSG (median age, 6.04 vs 4.04 years, P = 0.008). CONCLUSIONS While successful decannulation can be achieved without a PSG in some patients, PSG is a valuable tool to identify BPD patients undergoing clinical evaluation for decannulation who would benefit from treatment of OSA before decannulation.
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Affiliation(s)
- Courtney Quinlan
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joseph Piccione
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ji-Young Kim
- Clinical and Translational Research Center, Children's Hospital of Philadelphia, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Suzanne E Beck
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Sleep Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lee Brooks
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Sleep Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rosemary Chandy-Patel
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Emma Escobar
- Biostatistical and Informatics Cores of the Clinical and Translation Research Center of Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Olufunke Afolabi-Brown
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Sleep Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Dylag AM, Raffay TM. Rodent models of respiratory control and respiratory system development-Clinical significance. Respir Physiol Neurobiol 2019; 268:103249. [PMID: 31315068 DOI: 10.1016/j.resp.2019.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/24/2019] [Accepted: 06/29/2019] [Indexed: 01/13/2023]
Abstract
The newborn infant's respiratory system must rapidly adapt to extra-uterine life. Neonatal rat and mouse models have been used to investigate early development of respiratory control and reactivity in both health and disease. This review highlights several rodent models of control of breathing and respiratory system development (including pulmonary function), discusses their translational strengths and limitations, and underscores the importance of creating clinically relevant models applicable to the human infant.
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Affiliation(s)
- Andrew M Dylag
- Division of Neonatology, Golisano Children's Hospital, Department of Pediatrics, University of Rochester, Rochester, NY, United States
| | - Thomas M Raffay
- Division of Neonatology, Rainbow Babies & Children's Hospital, Department of Pediatrics, Case Western Reserve University, Cleveland, OH, United States.
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Autonomic maturation from birth to 2 years: normative values. Heliyon 2019; 5:e01300. [PMID: 30899829 PMCID: PMC6407160 DOI: 10.1016/j.heliyon.2019.e01300] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 02/03/2019] [Accepted: 02/27/2019] [Indexed: 01/11/2023] Open
Abstract
Background While heart rate variability (HRV) constitutes a relevant non-invasive tool to assess the autonomic nervous system (ANS) function with recognized diagnostic or therapeutic implications, there is still a lack of established data on maturation of autonomic control of heart rate during the first months of life. The Autonomic Baby Evaluation (AuBE) cohort was built to establish, the normal autonomic maturation profile from birth up to 2 years, in a healthy population of full-term newborns. Methods Heart rate variability analysis was carried out in 271 full-term newborns (mean gestational age 39 wGA + 5 days) from reliable polysomnographic recordings at 0 (n = 270) and 6 (n = 221) months and from a 24-hour ambulatory electrocardiogram (ECG) at 12 (n = 210), 18 (n = 197), and 24 (n = 190) months. Indices of HRV analysis were calculated through the ANSLabTools software. Results Indices are dissociated according a temporal, geometrical, frequency, Poincaré, empirical mode decomposition, fractal, Chaos and DC/AC and entropy analysis. Each index is presented for five different periods of time, 0, 6, 12, 18 and 24 months and with smoothed values in the 3rd, 10th, 50th, 90th and 97th percentiles. Data are also presented for the full cohort and individualized by sex to account for gender variability. Discussion & conclusion The physiological autonomic maturation profile from birth to 2 years in a healthy population of term neonates results in a fine-tuning autonomic maturation underlying progressively a new equilibrium and privileging the parasympathetic activity over the sympathetic activity.
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Oppersma E, Doorduin J, Gooskens PJ, Roesthuis LH, van der Heijden EHFM, van der Hoeven JG, Veltink PH, Heunks LMA. Glottic patency during noninvasive ventilation in patients with chronic obstructive pulmonary disease. Respir Physiol Neurobiol 2018; 259:53-57. [PMID: 30026086 DOI: 10.1016/j.resp.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Non-invasive ventilation (NIV) provides ventilatory support for patients with respiratory failure. However, the glottis can act as a closing valve, limiting effectiveness of NIV. This study investigates the patency of the glottis during NIV in patients with acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). METHODS Electrical activity of the diaphragm, flow, pressure and videolaryngoscopy were acquired. NIV was randomly applied in pressure support (PSV) and neurally adjusted ventilatory assist (NAVA) mode with two levels of support. The angle formed by the vocal cords represented glottis patency. RESULTS Eight COPD patients with acute exacerbation requiring NIV were included. No differences were found in median glottis angle during inspiration or peak inspiratory effort between PSV and NAVA at low and high support levels. CONCLUSIONS The present study showed that glottis patency during inspiration in patients with an acute exacerbation of COPD is not affected by mode (PSV or NAVA) or level of assist (5 or 15 cm H2O) during NIV.
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Affiliation(s)
- Eline Oppersma
- Cardiovascular and Respiratory Physiology, Faculty of Science and Technology, University of Twente, Postbox 217, 7500 AE, Enschede, The Netherlands; Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Postbox 217, 7500 AE, Enschede, The Netherlands; Department of Intensive Care Medicine, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Jonne Doorduin
- Department of Intensive Care Medicine, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands; Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Petra J Gooskens
- Cardiovascular and Respiratory Physiology, Faculty of Science and Technology, University of Twente, Postbox 217, 7500 AE, Enschede, The Netherlands; Department of Intensive Care Medicine, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Lisanne H Roesthuis
- Department of Intensive Care Medicine, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Erik H F M van der Heijden
- Department of Pulmonology, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Johannes G van der Hoeven
- Department of Intensive Care Medicine, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Peter H Veltink
- Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Postbox 217, 7500 AE, Enschede, The Netherlands.
| | - Leo M A Heunks
- Department of Intensive Care Medicine, Radboud University Medical Center, Postbox 9101, 6500 HB, Nijmegen, The Netherlands; Department of Intensive Care Medicine, Amsterdam UMC, Location VUmc, Postbox 7057, 1007MB, Amsterdam, The Netherlands.
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van der Heijden ME, Zoghbi HY. Loss of Atoh1 from neurons regulating hypoxic and hypercapnic chemoresponses causes neonatal respiratory failure in mice. eLife 2018; 7:e38455. [PMID: 29972353 PMCID: PMC6067883 DOI: 10.7554/elife.38455] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/01/2018] [Indexed: 12/12/2022] Open
Abstract
Atoh1-null mice die at birth from respiratory failure, but the precise cause has remained elusive. Loss of Atoh1 from various components of the respiratory circuitry (e.g. the retrotrapezoid nucleus (RTN)) has so far produced at most 50% neonatal lethality. To identify other Atoh1-lineage neurons that contribute to postnatal survival, we examined parabrachial complex neurons derived from the rostral rhombic lip (rRL) and found that they are activated during respiratory chemochallenges. Atoh1-deletion from the rRL does not affect survival, but causes apneas and respiratory depression during hypoxia, likely due to loss of projections to the preBötzinger Complex and RTN. Atoh1 thus promotes the development of the neural circuits governing hypoxic (rRL) and hypercapnic (RTN) chemoresponses, and combined loss of Atoh1 from these regions causes fully penetrant neonatal lethality. This work underscores the importance of modulating respiratory rhythms in response to chemosensory information during early postnatal life.
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Affiliation(s)
- Meike E van der Heijden
- Department of NeuroscienceBaylor College of MedicineHoustonUnited States
- Jan and Dan Duncan Neurological Research InstituteTexas Children’s HospitalHoustonUnited States
| | - Huda Y Zoghbi
- Department of NeuroscienceBaylor College of MedicineHoustonUnited States
- Jan and Dan Duncan Neurological Research InstituteTexas Children’s HospitalHoustonUnited States
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonUnited States
- Department of PediatricsBaylor College of MedicineHoustonUnited States
- Howard Hughes Medical InstituteBaylor College of MedicineHoustonUnited States
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17
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Ballester A, Gould F, Bond L, Stricklen B, Ohlemacher J, Gross A, DeLozier K, Buddington R, Buddington K, Danos N, German R. Maturation of the Coordination Between Respiration and Deglutition with and Without Recurrent Laryngeal Nerve Lesion in an Animal Model. Dysphagia 2018; 33:627-635. [PMID: 29476275 DOI: 10.1007/s00455-018-9881-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 02/15/2018] [Indexed: 01/02/2023]
Abstract
The timing of the occurrence of a swallow in a respiratory cycle is critical for safe swallowing, and changes with infant development. Infants with damage to the recurrent laryngeal nerve, which receives sensory information from the larynx and supplies the intrinsic muscles of the larynx, experience a significant incidence of dysphagia. Using our validated infant pig model, we determined the interaction between this nerve damage and the coordination between respiration and swallowing during postnatal development. We recorded 23 infant pigs at two ages (neonatal and older, pre-weaning) feeding on milk with barium using simultaneous high-speed videofluoroscopy and measurements of thoracic movement. With a complete linear model, we tested for changes with maturation, and whether these changes are the same in control and lesioned individuals. We found (1) the timing of swallowing and respiration coordination changes with maturation; (2) no overall effect of RLN lesion on the timing of coordination, but (3) a greater magnitude of maturational change occurs with RLN injury. We also determined that animals with no surgical intervention did not differ from animals that had surgery for marker placement and a sham procedure for nerve lesion. The coordination between respiration and swallowing changes in normal, intact individuals to provide increased airway protection prior to weaning. Further, in animals with an RLN lesion, the maturation process has a larger effect. Finally, these results suggest a high level of brainstem sensorimotor interactions with respect to these two functions.
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Affiliation(s)
- Ashley Ballester
- Department of Anatomy and Neurobiology, NEOMED, Rootstown, OH, 44272, USA.,Division of Obstetrics and Gynecology, Akron General Hospital, Akron, OH, USA
| | - François Gould
- Department of Anatomy and Neurobiology, NEOMED, Rootstown, OH, 44272, USA
| | - Laura Bond
- Department of Anatomy and Neurobiology, NEOMED, Rootstown, OH, 44272, USA
| | - Bethany Stricklen
- Department of Anatomy and Neurobiology, NEOMED, Rootstown, OH, 44272, USA
| | - Jocelyn Ohlemacher
- Department of Anatomy and Neurobiology, NEOMED, Rootstown, OH, 44272, USA
| | - Andrew Gross
- Department of Anatomy and Neurobiology, NEOMED, Rootstown, OH, 44272, USA
| | - Katherine DeLozier
- Department of Anatomy and Neurobiology, NEOMED, Rootstown, OH, 44272, USA
| | - Randall Buddington
- School of Health Studies, University of Memphis, Memphis, TN, 38152, USA
| | - Karyl Buddington
- Department of Biological Sciences, University of Memphis, Memphis, TN, 38152, USA
| | | | - Rebecca German
- Department of Anatomy and Neurobiology, NEOMED, Rootstown, OH, 44272, USA.
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18
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Ortiz LE, McGrath-Morrow SA, Sterni LM, Collaco JM. Sleep disordered breathing in bronchopulmonary dysplasia. Pediatr Pulmonol 2017; 52:1583-1591. [PMID: 29064170 PMCID: PMC5693767 DOI: 10.1002/ppul.23769] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/20/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND There are limited data on the effect of bronchopulmonary dysplasia (BPD) on sleep disordered breathing (SDB). We hypothesized that both the severity of prematurity and BPD would increase the likelihood of SDB in early childhood. Our secondary aim was to evaluate the association of demographic factors on the development of SDB. METHODS This is a retrospective study of patient factors and overnight polysomnogram (PSG) data of children enrolled in our BPD registry between 2008 and 2015. Association between PSG results and studied variables was assessed using multiple linear regression analysis. RESULTS One-hundred-forty children underwent at least one sleep study on room air. The mean respiratory disturbance index (RDI) was elevated at 9.9 events/hr (SD: 10.1). The mean obstructive apnea-hypopnea index (OAHI) was 6.5 (9.1) events/hr and the mean central event rate of 3.0 (3.7) events/hr. RDI had decreased by 22% or 1.5 events/hour (95%CI: 0.6, 1.9) with each year of age (P = 0.005). Subjects with more severe respiratory disease had 38% more central events (P = 0.02). Infants exposed to secondhand smoke had 2.4% lower (P = 0.04) oxygen saturation nadirs and a pattern for more desaturation events. Non-white subjects were found to have 33% higher OAHI (P = 0.05), while white subjects had a 61% higher rate of central events (P < 0.001). CONCLUSIONS RDI was elevated in a selected BPD population compared to norms for non-preterm children. BPD severity, smoke exposure, and race may augment the severity of SDB. RDI improved with age but was still elevated by age 4, suggesting that this population is at risk for the sequelae of SDB.
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Affiliation(s)
- Luis E Ortiz
- Johns Hopkins Medical Institutions, Baltimore, Maryland
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19
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Congenital central hypoventilation syndrome: An overview of etiopathogenesis, associated pathologies, clinical presentation, and management. Auton Neurosci 2017; 210:1-9. [PMID: 29249648 DOI: 10.1016/j.autneu.2017.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/10/2017] [Accepted: 11/12/2017] [Indexed: 12/19/2022]
Abstract
Congenital central hypoventilation syndrome (CCHS), known colloquially as Ondine's curse, is a rare disorder characterized by impaired autonomic control of breathing during sleep from the loss of vagal input and diminished sensitivity of CO2 receptors in the medulla. CCHS correlates to the malformation of the neural crest located in the brainstem; this consequently affects the loss of sensitivity of CO2 chemoreceptors, bringing about hypoventilation during sleep. The primary cause of CCHS is the mutation of the paired-like homeobox PHO2XB gene, found in 90% of the patients. This mutation not only affects breathing but also drives neurological abnormalities such as autonomic and neurocognitive dysfunction. Though typically congenital, there have been late-onset (i.e., acquired) cases reported. It is vital for physicians and clinicians to be able to diagnose CCHS due to its similar presentation to other syndromes and disorders, which may cause it to be misdiagnosed and may account for its deleterious effects. CCHS can lead to a constellation of symptoms, and consideration of diseases that present concomitantly with CCHS affords us a better understanding of the etiology of this illness. Although a rare syndrome, we aim to review the current literature to emphasize the pathogenesis, etiology, clinical presentation, symptoms, diagnosis, and current treatment methods of CCHS for clinicians to better identify and understand this condition.
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Fazio F, Arfuso F, Giudice E, Giannetto C, Piccione G. Physiological differences between twin and single-born lambs and kids during the first month of life. Arch Anim Breed 2016. [DOI: 10.5194/aab-59-201-2016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract. The effects of time after birth and of twinning on rectal temperature (RT), heart rate (HR), respiratory rate (RR) and body weight (BW) values were evaluated in five singleton Comisana lambs (three males and two females), five singleton Maltese Kids (three males and two females), four couples of twin Comisana lambs (four males and four females) and four couples of twin Maltese kids (four males and four females) during the first month of life. For all kids and lambs, RT, HR, RR and BW were recorded after 1 and 24 h from birth and every 2 days until the 30th day of life. The application of two-way repeated measures analysis of variance (ANOVA) showed a statistically significant effect of time (P < 0.0001) on RT, HR, RR and BW values in all lambs and kids during the first month of life. Any significant effect of twinning (P > 0.05) on all studied parameters was found in lambs, whereas statistically significant differences in BW, RT and HR values (P < 0.01) were found between twin and singleton kids throughout the first month of life. The results obtained in this study make a contribution to the knowledge of homeostatic, cardiorespiratory and thermoregulatory adaptations occurring in singleton lambs and kids and in twin lambs and kids during the first 30 days of life. Our findings indicate that the BW, RT, HR and RR values, whose homeostasis is still evolving in newborn, should be interpreted dynamically as a function of the period of postnatal adaptation and also of twinning.
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21
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Ulrich TJB, Ellsworth MA, Carey WA, Zubair AS, MacQueen BC, Colby CE, Ackerman MJ. Heart-rate-corrected QT interval evolution in premature infants during the first week of life. Pediatr Cardiol 2014; 35:1363-9. [PMID: 24894895 DOI: 10.1007/s00246-014-0937-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 05/15/2014] [Indexed: 01/08/2023]
Abstract
Automated monitoring of the QT interval is increasingly common in a variety of clinical settings. A better understanding of how the heart-rate-corrected QT interval (QTc) evolves in early postnatal life is needed before its clinical utility in neonates can be determined. This study aimed to use real-time bedside monitoring as a tool to describe the QTc evolution of premature neonates during the first week of life. All neonates born at a gestation age (GA) of 31 weeks or later and admitted to the level 2 intensive care nursery of the authors' institution between December 2012 and March 2013 were included in this study. The authors prospectively collected QTc values at 15-min intervals during the first week of life, then used two-way analysis of variance (ANOVA) to compare these data among three GA cohorts: 31 to <34 weeks (cohort A), 34 to <37 weeks (cohort B), and ≥37 weeks (cohort C). All the cohorts demonstrated a statistically significant decline in the 24-h average QTc during the first 3-4 days of life before reaching a stable baseline. No diurnal variation in the QTc was identified in any of the study patients. Marked variability and a progressive decline in the QTc of premature neonates occur during the first 3-4 days of life. Understanding this phenomenon is imperative when screening programs for the early detection of QT prolongation are considered.
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Affiliation(s)
- Timothy J B Ulrich
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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22
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Psaila K, Foster JP, Richards R, Jeffery HE. Non-nutritive sucking for gastro-oesophageal reflux disease in preterm and low birth weight infants. Cochrane Database Syst Rev 2014; 2014:CD009817. [PMID: 25315840 PMCID: PMC10907976 DOI: 10.1002/14651858.cd009817.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Gastro-oesophageal reflux (GOR) is commonly diagnosed in the neonatal population (DiPietro 1994), and generally causes few or no symptoms (Vandenplas 2009). Conversely, gastro-oesophageal reflux disease (GORD) refers to GOR that causes troublesome symptoms with or without complications such as damage to the oesophagus (Vandenplas 2009). Currently there is no evidence to support the range of measures recommended to help alleviate acid reflux experienced by infants. Non-nutritive sucking (NNS) has been used as an intervention to modulate neonatal state behaviours through its pacifying effects such as decrease infant fussiness and crying during feeds (Boiron 2007; Pickler 2004). OBJECTIVES To determine if NNS reduces GORD in preterm infants (less than 37 weeks' gestation) and low birth weight (less than 2500 g) infants, three months of age and less, with signs or symptoms suggestive of GORD, or infants with a diagnosis of GORD. SEARCH METHODS We performed computerised searches of the electronic databases of the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 9, 2013), MEDLINE (1966 to September 2013), CINAHL (1982 to September 2013), and EMBASE (1988 to September 2013). We applied no language restrictions. SELECTION CRITERIA Controlled trials using random or quasi-random allocation of preterm infants (less than 37 weeks' gestation) and low birth weight (less than 2500 g) infants three months of age and less with signs or symptoms suggestive of GORD, or infants with a diagnosis of GORD. We included studies reported only by abstracts, and cluster and cross-over randomised trials. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed and selected trials from searches, assessed and rated study quality and extracted relevant data. We identified two studies from the initial search. After further review, we excluded both studies. MAIN RESULTS We identified no studies examining the effects of NNS for GORD in preterm and low birth weight infants AUTHORS' CONCLUSIONS There was insufficient evidence to determine the effectiveness of NNS for GORD. Adequately powered RCTs on the effect of NNS in preterm and low birth weight infants diagnosed with GORD are required.
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Affiliation(s)
- Kim Psaila
- University of Western Sydney, College of Health and ScienceCHoRUS Project, Family and Community Health Research Group, School of Nursing and MidwiferyLocked Bag 1797Penrith South DCNSWAustralia1797
| | - Jann P Foster
- University of Western SydneySchool of Nursing & MidwiferySydneyNSWAustralia
- University of SydneyCentral Clinical School, Discipline of Obstetrics, Gynaecology and Neonatology, Sydney Medical School/Sydney Nursing SchoolSydneyNSWAustralia
| | - Robyn Richards
- Liverpool HospitalNewborn CareLocked Bag 7103South Western Sydney Area Health ServiceLiverpoolNSWAustralia1871
| | - Heather E Jeffery
- University of SydneySydney School of Public HealthSydneyNSWAustralia2050
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23
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Early blood gas predictors of bronchopulmonary dysplasia in extremely low gestational age newborns. Int J Pediatr 2014; 2014:210218. [PMID: 24959184 PMCID: PMC4052060 DOI: 10.1155/2014/210218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 03/06/2014] [Accepted: 04/28/2014] [Indexed: 11/17/2022] Open
Abstract
Aim. To determine among infants born before the 28th week of gestation to what extent blood gas abnormalities during the first three postnatal days provide information about the risk of bronchopulmonary dysplasia (BPD). Methods. We studied the association of extreme quartiles of blood gas measurements (hypoxemia, hyperoxemia, hypocapnea, and hypercapnea) in the first three postnatal days, with bronchopulmonary dysplasia, among 906 newborns, using multivariable models adjusting for potential confounders. We approximated NIH criteria by classifying severity of BPD on the basis of the receipt of any O2 on postnatal day 28 and at 36 weeks PMA and assisted ventilation. Results. In models that did not adjust for ventilation, hypoxemia was associated with increased risk of severe BPD and very severe BPD, while infants who had hypercapnea were at increased risk of very severe BPD only. In contrast, infants who had hypocapnea were at reduced risk of severe BPD. Including ventilation for 14 or more days eliminated the associations with hypoxemia and with hypercapnea and made the decreased risk of very severe BPD statistically significant. Conclusions. Among ELGANs, recurrent/persistent blood gas abnormalities in the first three postnatal days convey information about the risk of severe and very severe BPD.
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Abstract
Breathing movements have been demonstrated in the fetuses of every mammalian species investigated and are a critical component of normal fetal development. The classic sheep preparations instrumented for chronic fetal monitoring determined that fetal breathing movements (FBMs) occur in aggregates interspersed with long periods of quiescence that are strongly associated with neurophysiological state. The fetal sheep model also provided data regarding the neurochemical modulation of behavioral state and FBMs under a variety of in utero conditions. Subsequently, in vitro rodent models have been developed to advance our understanding of cellular, synaptic, network, and more detailed neuropharmacological aspects of perinatal respiratory neural control. This includes the ontogeny of the inspiratory rhythm generating center, the preBötzinger complex (preBötC), and the anatomical and functional development of phrenic motoneurons (PMNs) and diaphragm during the perinatal period. A variety of newborn animal models and studies of human infants have provided insights into age-dependent changes in state-dependent respiratory control, responses to hypoxia/hypercapnia and respiratory pathologies.
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Affiliation(s)
- John J Greer
- Department of Physiology, Centre for Neuroscience, Women and Children Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.
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25
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Patural H, Flori S, Pichot V, Barthelemy JC, Roche F. [Autonomic regulation and bradycardia during the neonatal period]. Arch Pediatr 2013; 21:226-30. [PMID: 24290181 DOI: 10.1016/j.arcped.2013.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 08/28/2013] [Accepted: 10/14/2013] [Indexed: 12/16/2022]
Abstract
The high frequency of bradycardia observed during the neonatal period requires cardiac monitoring but also understanding its intrinsic mechanisms, including responsiveness of the autonomic nervous system (ANS). Heart rate variability and spontaneous baroreflex analysis can help understand the autonomic dysregulation of cardiorespiratory control, possibly responsible for sudden infant death. In clinical neonatology practice, neonatal bradycardia does not warrant continuation of monitoring if it remains isolated, asymptomatic, and short (<10 s), followed by a rapid cardiac acceleration indicating an adapted sympathetic response. Further evaluation of ANS responsiveness is possible for newborns including analyzing the complexity of the heart rate and respiratory variability. This allows better targeting children with high risk after discharge. The real-time evaluation of autonomic regulation could become a valuable tool in clinical practice.
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Affiliation(s)
- H Patural
- Réanimation néonatale et pédiatrique, centre hospitalier universitaire de Saint-Étienne, 42005 Saint-Étienne, France; EA SNA-Epis 4607, université Jean-Monnet, 42023 Saint-Étienne, France.
| | - S Flori
- EA SNA-Epis 4607, université Jean-Monnet, 42023 Saint-Étienne, France
| | - V Pichot
- EA SNA-Epis 4607, université Jean-Monnet, 42023 Saint-Étienne, France
| | - J-C Barthelemy
- EA SNA-Epis 4607, université Jean-Monnet, 42023 Saint-Étienne, France
| | - F Roche
- EA SNA-Epis 4607, université Jean-Monnet, 42023 Saint-Étienne, France
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26
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Fischer HS, Bührer C. Avoiding endotracheal ventilation to prevent bronchopulmonary dysplasia: a meta-analysis. Pediatrics 2013; 132:e1351-60. [PMID: 24144716 DOI: 10.1542/peds.2013-1880] [Citation(s) in RCA: 195] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Mechanical ventilation via an endotracheal tube is a risk factor for bronchopulmonary dysplasia (BPD), one of the most common morbidities of very preterm infants. Our objective was to investigate the effect that strategies to avoid endotracheal mechanical ventilation (eMV) have on the incidence of BPD in preterm infants <30 weeks' gestational age (GA). METHODS In February 2013, we searched the databases Medline, Embase, and the Cochrane Central Register of Controlled Trials. Study selection criteria included randomized controlled trials published in peer-reviewed journals since the year 2000 that compared preterm infants <30 weeks' GA treated by using a strategy aimed at avoiding eMV with a control group in which mechanical ventilation via an endotracheal tube was performed at an earlier stage. Data were extracted and analyzed by using the standard methods of the Cochrane Neonatal Review Group. The authors independently assessed study eligibility and risk of bias, extracted data and calculated odds ratios and 95% confidence intervals, employing RevMan version 5.1.6. RESULTS We identified 7 trials that included a total of 3289 infants. The combined odds ratio (95% confidence interval) of death or BPD was 0.83 (0.71-0.96). The number needed to treat was 35. The study results were remarkably homogeneous. Avoiding eMV had no influence on the incidence of severe intraventricular hemorrhage. CONCLUSIONS Strategies aimed at avoiding eMV in infants <30 weeks' GA have a small but significant beneficial impact on preventing BPD.
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Affiliation(s)
- Hendrik S Fischer
- Klinik für Neonatologie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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Bairam A, Lumbroso D, Joseph V. Effect of progesterone on respiratory response to moderate hypoxia and apnea frequency in developing rats. Respir Physiol Neurobiol 2013; 185:515-25. [DOI: 10.1016/j.resp.2012.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 10/31/2012] [Accepted: 11/01/2012] [Indexed: 01/18/2023]
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Tutor JD, Gosa MM. Dysphagia and aspiration in children. Pediatr Pulmonol 2012; 47:321-37. [PMID: 22009835 DOI: 10.1002/ppul.21576] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 08/11/2011] [Indexed: 11/08/2022]
Abstract
Aspiration is a significant cause of respiratory morbidity and sometimes mortality in children. It occurs when airway protective reflexes fail, especially, when dysphagia is also present. Clinical symptoms and physical findings of aspiration can be nonspecific. Advances in technology can lead to early diagnosis of dysphagia and aspiration, and, new therapeutic advances can significantly improve outcome and prognosis. This report first reviews the anatomy and physiology involved in the normal process of swallowing. Next, the protective reflexes that help to prevent aspiration are discussed followed by the pathophysiologic events that occur after an aspiration event. Various disease processes that can result in dysphagia and aspiration in children are discussed. Finally, the various methods for diagnosis and treatment of dysphagia in children are reviewed.
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Affiliation(s)
- James D Tutor
- Program in Pediatric Pulmonary Medicine, University of Tennessee Health Science Center, LeBonheur Children's Hospital, St. Jude Children's Research Hospital, Memphis, Tennessee 38103, USA.
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Beck J, Reilly M, Grasselli G, Qui H, Slutsky AS, Dunn MS, Sinderby CA. Characterization of neural breathing pattern in spontaneously breathing preterm infants. Pediatr Res 2011; 70:607-13. [PMID: 21857389 PMCID: PMC3210880 DOI: 10.1203/pdr.0b013e318232100e] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim was to characterize the neural breathing pattern in nonintubated preterm infants. The diaphragm electrical activity (EAdi) and heart rate were simultaneously measured repeatedly for 1 h over several days using a modified feeding tube equipped with miniaturized sensors. The EAdi waveform was quantified for phasic and tonic activity, neural timings, and prevalence of recurring patterns, including central apnea. Ten infants with mean age 7 d (range, 3-13 d) were studied. Their birth weight was 1512 g (1158-1800 g) and GA at birth 31 wk (28-36 wk). Neural inspiratory and expiratory times were 278 ms (195-450 ms) and 867 ms (668-1436 ms) and correlated with GA (p < 0.001). Tonic EAdi represented 29.5% of phasic EAdi (16-40%) and was related to GA (r = 0.61, p < 0.001). For the group, 68% of the time was regular phasic breathing (without tonic activity) and 29% of the time with elevated tonic activity. Central apneas >5 s occurred on average 10 times per hour (2-29). Heart rate reductions were correlated to central apnea duration. In conclusion, esophageal recordings of the EAdi waveform demonstrate that neural breathing pattern is variable, with regards to timing, amplitude, and pattern with a distinct amount of tonic diaphragm activity.
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Affiliation(s)
- Jennifer Beck
- Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario M5B 1W8, Canada.
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Poets CF, Brockmann PE. Myth: gastroesophageal reflux is a pathological entity in the preterm infant. Semin Fetal Neonatal Med 2011; 16:259-63. [PMID: 21664203 DOI: 10.1016/j.siny.2011.05.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There is concern about possible consequences of gastroesophageal reflux (GER) in preterm infants. GER is perceived to be a frequent condition in these infants, often causing an exhaustive investigation and expensive therapy. We review current evidence for and against an association between GER and apnea, failure to thrive, wheezing and respiratory diseases. Although there are some limitations to the methodologies currently used for detecting GER, there is clearly a lack of unequivocal evidence supporting a causal relationship between GER and its assumed consequences, particularly in preterm infants. Despite physiologic data that stimulation of laryngeal efferents by GER may induce apnea, there is little evidence for a causal relationship between GER and apnea. Studies on preterm infants with failure to thrive have also not demonstrated an association between the latter and GER in most cases, and there is equally little evidence for a casual relationship with respiratory problems. Therefore, we believe that GER in preterm infants is only rarely associated with serious consequences and existing evidence does not support the widespread use of anti-reflux medications for treatment of these signs in this age group. An improvement of methods to identify the few preterm infants at risk for developing serious consequences of GER is urgently needed.
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Affiliation(s)
- Christian F Poets
- Department of Neonatology, University Children's Hospital, Tübingen, Germany.
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31
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Julien CA, Joseph V, Bairam A. Alteration of carotid body chemoreflexes after neonatal intermittent hypoxia and caffeine treatment in rat pups. Respir Physiol Neurobiol 2011; 177:301-12. [DOI: 10.1016/j.resp.2011.05.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 05/10/2011] [Accepted: 05/10/2011] [Indexed: 01/01/2023]
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Yamamoto Y, Hashiguchi M, Yamaguchi-Yamada M. Morphological development and expression of neurotrophin receptors in the laryngeal sensory corpuscles. Anat Rec (Hoboken) 2011; 294:694-705. [PMID: 21370491 DOI: 10.1002/ar.21344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 09/29/2010] [Accepted: 09/30/2010] [Indexed: 02/04/2023]
Abstract
Morphological development of sensory structures in the laryngeal mucosa of postnatal rats was observed by use of immunohistochemistry for protein gene-product 9.5 (PGP9.5). Moreover, expression changes of high affinity neurotrophin receptors, TrkA, TrkB and TrkC, and low affinity neurotrophin receptor p75(NTR) were examined to elucidate the relationship to morphogenesis. Intraepithelial nerve endings and parent axons of the laminar endings with immunoreactivity for PGP9.5 have already appeared in the rat on embryonic day 18 (E18) as well as solitary chemoreceptor cells in the glottic cleft. According to neurotrophin receptors, TrkA immunoreactivity were observed on and after postnatal week 3 (3W) in the nervous sensory structures, that is, free nerve endings, laminar endings and sub- and intragemmal plexuses of the taste buds. In the laminar endings, TrkC immunoreactivity was also observed on and after 3W. According to the laryngeal sensory cells, the solitary chemoreceptor cells were immunoreactive to TrkA, TrkB, and TrkC on and after postnatal day 3 (P3). In the taste buds in arytenoid region, taste cells were immunoreactive for TrkA, TrkB, and TrkC on and after 3W, P14, and 3W, respectively. Immunoreactivity for p75(NTR) was observed on the surface of taste cells on and after P9. The results of the present study suggest that sensory structures in the laryngeal mucosa were developed on perinatal days to involve respiratory reflex, and that neurotrophin receptors may take part in the regulation and maintenance of sensory structures.
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Affiliation(s)
- Yoshio Yamamoto
- Laboratory of Veterinary Biochemistry and Cell Biology, Faculty of Agriculture, Department of Veterinary Sciences, Iwate University, Morioka, Iwate, Japan.
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Omari TI. Apnea-associated reduction in lower esophageal sphincter tone in premature infants. J Pediatr 2009; 154:374-8. [PMID: 18950796 DOI: 10.1016/j.jpeds.2008.09.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 06/27/2008] [Accepted: 09/02/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To characterize esophageal motility during episodes of prolonged apnea in premature infants. STUDY DESIGN We retrospectively reviewed combined manometric and physiological monitoring studies performed in tube-fed premature infants from 1994 to 2002. Apnea was defined as a respiratory pause of >20 seconds. For each apneic event, pharyngeal swallowing, esophageal motility, and lower esophageal sphincter (LES) pressure were assessed before, during, and after apneic episodes. RESULTS Twelve episodes of apnea (duration, 20 to 120 seconds) were identified in 7 infants (34 to 37 weeks postmenstrual age (PMA); study weight, 1950 to 2380 g). During the apneic episodes, swallowing increased (median[interquartile range], 0[0,0], 5[4,7], and 1[0,2] swallows/minute before, during, and after apnea, respectively; P < .05), esophageal pressure wave sequences (PWS) increased (1[0,2], 5[3,6], and 2[1,3] PWS/minute before, during, and after apnea, respectively; P < .05) and LES pressure decreased (16[12,21], 6[5,8], and 27[12,32] mmHg before, during, and after apnea, respectively; P < .05). CONCLUSION In premature infants, apnea is associated with reduced LES tone, potentially increasing the likelihood of reflux occurring after the onset of apnea.
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Affiliation(s)
- Taher I Omari
- Gastroenterology Unit, Children, Youth and Women's Health Services, North Adelaide, Australia.
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Paul K, Melichar J, Miletín J, Dittrichová J. Differential diagnosis of apneas in preterm infants. Eur J Pediatr 2009; 168:195-201. [PMID: 18758814 DOI: 10.1007/s00431-008-0731-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 03/26/2008] [Accepted: 03/29/2008] [Indexed: 11/25/2022]
Abstract
Clinically relevant apneas, which are common in preterm infants, may adversely affect later neuropsychological condition in this group of patients. Pharmacotherapy to stimulate respiratory functions may be unsuccessful. Polygraphic recording may help in the differential diagnosis of these clinically relevant events. Twenty-nine preterm neonates born before 36 weeks of gestational age were examined using polygraphic recording (respiration--two channels, perioral electromyography, oxygen saturation, heart rate, electroencephalography, electrocardiography, electrooculography). The examination was ordered by the attending physician after an unsuccessful treatment of apnea by Aminophylline, and it should contribute to the clarification of the causes of these events. In the course of the polygraphic examinations, altogether 63 episodes were recorded during which the pulse oximeter alarm signal was set off. In 42 cases, the alarm signal was set off in events during which SaO(2) fell below 85%. In the remaining 21 cases, the alarm signal was set off in episodes during which early bradycardia below 90/min occurred. The onset of apnea was very often associated with the phasic increase of the perioral electromyography and with electroencephalography arousal reaction. Because of suspicion that these apneas may be triggered by episodes of gastroesophageal reflux, the interruption of the Aminophylline treatment and setting up an antireflux regimen were recommended. These therapeutic measures had a positive effect: The frequency of alarm signals decreased within 48 h by a statistically significant 50%. In cases where the pharmacotherapy of apnea by stimulation of respiratory functions is not successful, differential diagnostic analysis should be performed. Polygraphy may contribute to the clarification of the causes underlying clinically relevant apneas in a view of newly described polygraphic signs. It is feasible to suspect, based on these signs, that gastroesophageal reflux is the cause for clinically significant apneas in that case.
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Affiliation(s)
- Karel Paul
- Institute for the Care of Mother and Child, Podolské nábrezí 157, CZ 14710 Praha 4, Czech Republic.
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Xia L, Crane-Godreau M, Leiter JC, Bartlett D. Gestational cigarette smoke exposure and hyperthermic enhancement of laryngeal chemoreflex in rat pups. Respir Physiol Neurobiol 2008; 165:161-6. [PMID: 19041957 DOI: 10.1016/j.resp.2008.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 10/27/2008] [Accepted: 11/04/2008] [Indexed: 01/05/2023]
Abstract
Laryngeal chemoreflex (LCR) apnea occurs in infant mammals of many species in response to water or other liquids in the laryngeal lumen. The apnea can last for many seconds, sometimes leading to dangerous hypoxemia, and has therefore been considered as a possible mechanism in the Sudden Infant Death Syndrome (SIDS). We have found recently that this reflex is markedly prolonged in decerebrate piglets and anesthetized rat pups that are warmed 1-3 degrees C above their normal body temperatures. We intermittently exposed pregnant rats to cigarette smoke and examined the LCR in their four- to fifteen-day-old offspring under general anesthesia, with and without whole body warming. During warming, pups of gestationally smoke-exposed dams had significantly longer LCR-induced respiratory disruption than similarly warmed control pups. The results may be significant for the pathogenesis and/or prevention of SIDS as maternal cigarette smoking during human pregnancy and heat stress in infants are known risk factors for SIDS.
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Affiliation(s)
- Luxi Xia
- Department of Physiology, Dartmouth Medical School, One Medical Center Drive, Lebanon, NH 03756, USA
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Abstract
Apnea of prematurity (AOP) remains a major clinical problem in present day neonatology that warrants frequent evaluations and imposes challenges in therapeutic strategies. Although the pathogenesis of AOP is poorly understood, it is probably a manifestation of physiologic immaturity of breathing control rather than a pathologic disorder. Immature breathing responses to hypoxia, hypercapnia and exaggerated inhibitory pulmonary reflexes in preterm infants might also contribute to the occurrence or severity of AOP. Recent data suggest a role for genetic predisposition. Although typically resolve with maturation, the role of bradycardia and desaturation episodes associated with AOP in the development of sleep disorder breathing and neurodevelopmental delay needs further clarification. Pharmacological treatment with methylxanthines and CPAP remain the mainstay for treatment of AOP. However, recent studies have implicated central inhibitory neuromodulators including prostaglandins, GABA and adenosine in its pathogenesis, the fact that might provide future specific targets for treatment. This review will summarize new insights involving these issues as well as others involving the pathogenesis, treatment strategies and consequences of apnea in premature infants.
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Affiliation(s)
- Jalal M Abu-Shaweesh
- Rainbow Babies & Children's Hospital, Case Western Reserve University, School of Medicine, Cleveland, Ohio 44106-6010, USA
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Mesner O, Miller MJ, Iben SC, Kc P, Mayer CA, A. Haxhiu M, Martin RJ. Hyperbilirubinemia diminishes respiratory drive in a rat pup model. Pediatr Res 2008; 64:270-4. [PMID: 18458654 PMCID: PMC2574887 DOI: 10.1203/pdr.0b013e31817d9c0c] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although apnea is common in premature babies, there is a paucity of information concerning the pathophysiologic basis of these episodes and their relationship to other perinatal conditions such as hyperbilirubinemia. Unconjugated hyperbilirubinemia in premature infants, even in moderately high levels, may cause encephalopathy affecting brainstem functions and has been linked to increased incidence of apnea in these infants. Thus, there is a need to clarify mechanisms by which bilirubin may alter respiratory control and induce apnea of prematurity. In this study, bilirubin or placebo was infused i.v. in 9-d-old rat pups (n = 36). Serum hyperbilirubinemia peaked in the first hours after bilirubin infusion. Twenty-four hours after bilirubin infusion, respiration was recorded by plethysmography at rest and under hypercapnic and hypoxic conditions. In treated pups, minute ventilation in room air was significantly reduced, hyperventilatory response to CO2 was blunted, and hypoxic ventilatory depression was increased, compared with placebo-injected rat pups. Brainstem bilirubin deposition and immunoreactivity to bilirubin was detected in the brainstem on histologic analysis. We speculate that high serum bilirubin levels may cause prolonged inhibition of brainstem autonomic function and that this could underlie the exacerbation of apnea noted in premature babies who have experienced jaundice.
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Affiliation(s)
- Oded Mesner
- Division of Neonatology, Soroka Medical Center, Ben-Gurion University, POB 151, Beer-Sheva, Israel, 84101
| | - Martha J. Miller
- Division of Neonatology, Department of Pediatrics, Rainbow Babies and Children Hospital, Case Western Reserve University, Cleveland, Ohio, U.S.A.,Corresponding author: Martha J. Miller M.D., Ph.D., Division of Neonatology, Department of Pediatrics, Rainbow Babies and Childrens Hospital, 11100 Euclid, Cleveland, Ohio, U.S.A., 44106 E-mail:
| | - Sabine C. Iben
- Division of Neonatology, Department of Pediatrics, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.,44195
| | - Prabha Kc
- Division of Neonatology, Department of Pediatrics, Rainbow Babies and Children Hospital, Case Western Reserve University, Cleveland, Ohio, U.S.A
| | - Catherine A. Mayer
- Division of Neonatology, Department of Pediatrics, Rainbow Babies and Children Hospital, Case Western Reserve University, Cleveland, Ohio, U.S.A
| | - Musa A. Haxhiu
- Division of Neonatology, Department of Pediatrics, Rainbow Babies and Children Hospital, Case Western Reserve University, Cleveland, Ohio, U.S.A
| | - Richard J. Martin
- Division of Neonatology, Department of Pediatrics, Rainbow Babies and Children Hospital, Case Western Reserve University, Cleveland, Ohio, U.S.A
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Slocum C, Hibbs AM, Martin RJ, Orenstein SR. Infant apnea and gastroesophageal reflux: a critical review and framework for further investigation. Curr Gastroenterol Rep 2007; 9:219-24. [PMID: 17511920 DOI: 10.1007/s11894-007-0022-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Gastroesophageal reflux and apnea of prematurity are both common occurrences in premature infants. However, a causal relationship between the two remains controversial. Strong physiologic evidence indicates that a variety of protective reflex responses may elicit laryngeal adduction and apnea. Although a potential link between gastroesophageal reflux and apnea may exist through this pathway, clinical studies can be cited to either support or refute such a link in premature infants. The majority of gastroesophageal reflux episodes do not appear to be related to apnea. In a specific subset of events, a causal relationship may exist. Whether this is related to the character of the reflux episode or to a predisposition in a subpopulation of infants is unclear. This review presents the evidence for and against an association between gastroesophageal reflux and apnea, discusses techniques used in their evaluation, and identifies approaches for future investigation.
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Affiliation(s)
- Christopher Slocum
- Division of Neonatology, Rainbow Babies and Children's Hospital, Suite 3100, Cleveland, OH 44106, USA
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40
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Teig N, Rieger CHL. Erregerbedingte Atemregulationsstörungen bei Säuglingen. SOMNOLOGIE 2007. [DOI: 10.1007/s11818-006-0291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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41
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Erregerbedingte Atemregulationsstörungen bei Säuglingen. SOMNOLOGIE 2006. [DOI: 10.1007/s11818-006-291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
We review cough from premature birth, mature neonatal life, in childhood and adult life, and in old age. There is a regrettable lack of definitive studies, but many clues in the literature. The cough reflex seems weak in premature infants, but develops with maturity. It is pronounced in childhood, but there seem to be no studies comparing its strength then with that in adulthood. In old age the cough may weaken, as indicated by the prevalence of aspiration pneumonia. These changes are presumably related to the development and degeneration of the afferent and central nervous pathways for cough, which may be reflected in the changes in laryngeal muscle function with age. There is much evidence that age influences the development of the respiratory system in general, and of the immune system which would affect the degree, frequency and clinical issues of cough. Other factors that limit our understanding of the changes in cough with age include the reporting of cough by parents in infants and carers in old age and the use of different diagnostic criteria throughout life. Age-related variation in cough sensitivity seems to be well established, but its quantitation and mechanisms require much further research.
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Affiliation(s)
- Anne B Chang
- Department Respiratory Medicine, Royal Children's Hospital, Herston, Queensland 4029, Australia.
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Baldwin DN, Pillow JJ, Stocks J, Frey U. Lung-function tests in neonates and infants with chronic lung disease: tidal breathing and respiratory control. Pediatr Pulmonol 2006; 41:391-419. [PMID: 16555264 DOI: 10.1002/ppul.20400] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This paper is the fourth in a series of reviews that will summarize available data and critically discuss the potential role of lung-function testing in infants with acute neonatal respiratory disorders and chronic lung disease of infancy. The current paper addresses information derived from tidal breathing measurements within the framework outlined in the introductory paper of this series, with particular reference to how these measurements inform on control of breathing. Infants with acute and chronic respiratory illness demonstrate differences in tidal breathing and its control that are of clinical consequence and can be measured objectively. The increased incidence of significant apnea in preterm infants and infants with chronic lung disease, together with the reportedly increased risk of sudden unexplained death within the latter group, suggests that control of breathing is affected by both maturation and disease. Clinical observations are supported by formal comparison of tidal breathing parameters and control of breathing indices in the research setting.
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Affiliation(s)
- David N Baldwin
- Centre for Child Health Research and Telethon Institute for Child Health Research, University of Western Australia, Perth, Western Australia, Australia.
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Abstract
Great strides have been made in our understanding of developmental respiratory neurobiology. A clear picture is, therefore, emerging of the physiological mechanisms that underlie apnea of prematurity. The ventral surface of the medulla and adjacent areas play a key integrative function for central CO2 chemosensitivity and modulation of afferent inputs from peripheral chemoreceptors and laryngeal afferents. Maturational change in medullary neurotransmitter function appears to contribute to the physiological events that characterize apnea of prematurity. Despite this greater scientific insight, therapeutic strategies for neonatal apnea have changed little in 30 years. Xanthine therapy and continuous positive airway pressure remain the mainstay of therapy while other therapeutic approaches have been inadequately studied. Our understanding of a possible relationship between the triad of apnea, bradycardia and desaturation, and impaired neurodevelopmental outcome is also limited. These are all issues that need our attention if optimal therapy and outcome are to be provided for preterm infants with immature respiratory control.
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Affiliation(s)
- Richard J Martin
- Division of Neonatology, Department of Pediatrics, Case Western Reserve University, OH 44106 , USA.
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Abstract
Apnea, the cessation of respiratory airflow, can begin in many preterm infants in the first week of life and can last until the day of discharge or beyond. This article provides an overview of the complex anatomic, physiological, and developmental mechanisms related to immaturity of both the central nervous system and musculature of the pulmonary system, that contribute to apnea of prematurity. Apnea of prematurity is a diagnosis of exclusion; an array of other conditions and stimuli can also cause apnea, including infections, pulmonary disease, and intracranial pathology. The standard clinical management of apnea, including cutaneous stimulation, methylxanthine therapy, and continuous positive airway pressure or ventilatory support, are discussed as well as newer investigational therapies, such as olfactory stimulation. Emerging evidence on the long-term neurodevelopmental impact of apnea is reviewed. Nursing measures to prevent and manage apnea are reviewed with an emphasis on parent education and preparation for discharge. Apnea resolves in most preterm infants as they approach term corrected gestational age; however, if it does not, options include continued hospitalization or, for infants with stable apnea, discharge with a home apnea monitor.
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MESH Headings
- Apnea/diagnosis
- Apnea/mortality
- Apnea/nursing
- Central Nervous System Stimulants/therapeutic use
- Combined Modality Therapy
- Continuity of Patient Care
- Drug Therapy, Combination
- Female
- Follow-Up Studies
- Gestational Age
- Home Nursing
- Humans
- Infant, Newborn
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/mortality
- Infant, Premature, Diseases/nursing
- Infant, Very Low Birth Weight
- Intensive Care Units, Neonatal
- Male
- Monitoring, Ambulatory/instrumentation
- Monitoring, Ambulatory/methods
- Neonatal Nursing/standards
- Neonatal Nursing/trends
- Nurse's Role
- Positive-Pressure Respiration
- Risk Assessment
- Severity of Illness Index
- Survival Rate
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Abstract
Gastroesophageal reflux (GER) and apnea are both common occurrences in premature infants but their relationship is controversial. We present the evidence for and against an association between GER and apnea and discuss the merits and limitations of the various methodologies employed in characterizing such a relationship. Overall, GER and apnea do not appear temporally related in preterm infants, despite strong physiologic evidence that stimulation of laryngeal afferents elicits central apnea and laryngeal adduction. In a subpopulation of infants with neurodevelopmental compromise, there may be an increased incidence of both apnea and GER, although the direct association between GER and apnea in this population is unclear. Therefore, we believe there is no evidence to support widespread use of anti-reflux medications in the treatment of apnea in preterm infants. Further studies are needed to clarify the existence of a small subpopulation of infants who may have GER-induced apnea, to identify potential triggering mechanisms, and to document benefit from newer pharmacological approaches.
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Affiliation(s)
- Eleanor J Molloy
- Division of Neonatology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH 44106, USA
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