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Hayashi A, Suresh S, Kevat A, Robinson J, Kapur N. Central sleep apnea in otherwise healthy term infants. J Clin Sleep Med 2022; 18:2813-2817. [PMID: 35962944 PMCID: PMC9713904 DOI: 10.5664/jcsm.10228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES To describe the outcomes of central sleep apnea requiring home supplemental oxygen therapy in otherwise healthy term infants. METHODS All children < 1 year of age undergoing polysomnography between 2015 and 2020 at the Queensland Children's Hospital were retrospectively studied. Children with gestational age < 37 weeks, underlying syndrome, cleft palate, those with obstructive apnea-hypopnea index > 50% of total apnea-hypopnea index, or with underlying cardiac or pulmonary parenchymal pathology were excluded. Polysomnography parameters were extracted for periods both on and off supplemental oxygenation. RESULTS Fifty-two (mean [standard deviation] age at polysomnography 32.6 [34.7] days; 21 females) term infants were included. There was a statistically significant improvement in apnea-hypopnea index on supplemental oxygen (mean [standard deviation] in room air 50.2 [36.3] vs 11.6 [9], P < .001 on supplemental oxygen), in both rapid eye movement and nonrapid eye movement sleep, as well as in mean oxygen saturations (96.6% in room air to 98.9% on oxygen; P < .001). There was no statistically significant change in transcutaneous carbon dioxide levels or sleep duration. Oxygenation was prescribed for a median (interquartile range) age of 197 (127) days. CONCLUSIONS Central sleep apnea in term infants who are otherwise healthy generally has a good prognosis, with oxygen therapy prescribed for around 6 months. Oxygen therapy was associated with improved saturations and decrease in apnea-hypopnea index when assessed with polysomnography. CITATION Hayashi A, Suresh S, Kevat A, Robinson J, Kapur N. Central sleep apnea in otherwise healthy term infants. J Clin Sleep Med. 2022; 18(12):2813-2817.
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Affiliation(s)
- Ayaka Hayashi
- Queensland Children’s Hospital, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Sadasivam Suresh
- Queensland Children’s Hospital, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Ajay Kevat
- Queensland Children’s Hospital, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Jacob Robinson
- Queensland Children’s Hospital, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Nitin Kapur
- Queensland Children’s Hospital, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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Flint A, August D, Lai M, Chawla J, Ballard E, Davies MW. Determining reference data for overnight oximetry in neonates: A pilot study. Early Hum Dev 2022; 168:105571. [PMID: 35390559 DOI: 10.1016/j.earlhumdev.2022.105571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the variability of overnight oximetry parameters in a group of normal, healthy term infants; to enable the calculation of the number of subjects required to produce reliable reference ranges for neonatal overnight oximetry. METHODS A convenience sample of normal, healthy term neonates was recruited. Each had overnight oximetry using the Masimo SET Radical oximeter (data downloaded using Profox software). The report included the number of oxygen desaturation events (an absolute decrease in SpO2 of 4 or more), and the duration of oxygen saturations <90%. RESULTS 21 babies were recruited with data available from 19. 32% were female; 68% born by vaginal delivery; 37% fully breast feeding, 53% bottle and 11% by a combination of both. The mean (SD) GA was 39.2 (0.79) weeks, the mean (SD) BW was 3477 (240) grams. The median (IQR) post-natal age at the time the oximetry recording started was 31 (28-41) hours; four babies were <24 h old. All babies had some desaturation events ranging from 4 to 36 times per hour. On average babies spent 3.0% (SD 2.3) of the time with an SpO2 < 90% (range 0.12-7.94). CONCLUSIONS In a cohort of healthy term neonates, as assessed by overnight oximetry, the mean SpO2 was 97% (SD 1, range 95-99). All neonates had a number of oxygen desaturation events ranging from 4 to 36 per hour. The mean proportion of time spent with oxygen saturations below 90% was around 3%.
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Affiliation(s)
- Anndrea Flint
- Neonatal Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Deanne August
- Grantley Stable Neonatal Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Melissa Lai
- Grantley Stable Neonatal Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jasneek Chawla
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Emma Ballard
- Statistics Unit, QIMR Berghofer Medical Research Institute, Australia
| | - Mark W Davies
- Grantley Stable Neonatal Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Clinical Medicine - Royal Brisbane Clinical Unit, University of Queensland, Brisbane, Queensland, Australia.
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White H, Sobelman C, Kremer T, Lee A, Rhein LM. Does recorded oximetry utilizing a consensus-based algorithm compare to polysomnography in discontinuing home oxygen therapy in premature infants? Pediatr Pulmonol 2022; 57:476-482. [PMID: 34811971 DOI: 10.1002/ppul.25770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/10/2021] [Accepted: 11/05/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Approximately a third of all extremely preterm infants diagnosed with bronchopulmonary dysplasia will require home oxygen therapy (HOT). Lack of consensus-based guidelines has led to significant variability in outpatient HOT management in the United States. A common assessment performed before discontinuing oxygen is a formal polysomnogram (PSG). PSGs are potentially undesirable due to cost, lack of convenient access, and parental stress, so alternative testing to determine the optimal timing of safe oxygen discontinuation are needed. METHODS We compared nocturnal recorded home oximetry (RHO) with PSG data in a cohort of patients from the RHO trial for patients who had recordings performed simultaneously to or within 24 h of their PSG. The RHO trial was a randomized, unblinded, multi-center trial comparing two oxygen management strategies. Parameters of oxygenation were compared between PSG and RHO, and nonoximegtry findings from the PSG that changed clinical management were identified. RESULTS A total of 53 infants randomized to obtain a PSG as part of the RHO trial (55%) completed a PSG, and of those, 32 (64%) completed both a PSG with comparison RHO. There were more white infants in both groups than other races and ethnicities. Bland-Altman analysis showed a strong agreement of oxygen saturation time below 90% SpO2 between PSG and RHO results (slope = 1.014, p = 0.24). Results agreed in 96% of cases. CONCLUSION RHO is a safe and effective alternative to PSG to assist in determination of discontinuing HOT in infants with BPD without other risks for sleep-disordered breathing.
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Affiliation(s)
- Heather White
- Division of Neonatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Division of Pediatric Pulmonology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Celia Sobelman
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ted Kremer
- Division of Pediatric Pulmonology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Austin Lee
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Lawrence M Rhein
- Division of Neonatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Division of Pediatric Pulmonology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Everitt LH, Awoseyila A, Bhatt JM, Johnson MJ, Vollmer B, Evans HJ. Weaning oxygen in infants with bronchopulmonary dysplasia. Paediatr Respir Rev 2021; 39:82-89. [PMID: 33309219 DOI: 10.1016/j.prrv.2020.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/30/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease commonly seen in preterm infants as the sequelae following respiratory distress syndrome. The management of evolving BPD aims to minimise lung injury and prevent the impact of hypoxia and hyperoxia. Proposed morbidities include respiratory instability, pulmonary hypertension, suboptimal growth, altered cerebral oxygenation and long-term neurodevelopmental impairment. The ongoing management and associated morbidity present a significant burden for carers and healthcare systems. Long-term oxygen therapy may be required for variable duration, though there is a lack of consensus and wide variation in practise when weaning supplemental oxygen. Furthermore, a shift in care towards earlier discharge and community care underlines the importance of a structured discharge and weaning process that eliminates the potential risks associated with hypoxia and hyperoxia. This review article describes recent evidence outlining oxygen saturation reference ranges in young infants, on which structured guidance can be based.
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Affiliation(s)
- Lucy H Everitt
- Department of Respiratory Paediatrics, Southampton Children's Hospital, Southampton, UK
| | - Adejumoke Awoseyila
- Department of Paediatrics, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Jayesh M Bhatt
- Department of Respiratory Paediatrics, Nottingham Children's Hospital, Nottingham, UK
| | - Mark J Johnson
- Department of Neonatal Medicine, Southampton Children's Hospital, Southampton, UK; NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Brigitte Vollmer
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Neonatal and Paediatric Neurology, Southampton Children's Hospital, Southampton, UK
| | - Hazel J Evans
- Department of Respiratory Paediatrics, Southampton Children's Hospital, Southampton, UK.
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Wong MD, Neylan M, Williams G, Zahir SF, Chawla J. Predictors of home oxygen duration in chronic neonatal lung disease. Pediatr Pulmonol 2021; 56:992-999. [PMID: 33621433 DOI: 10.1002/ppul.25257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/24/2020] [Accepted: 12/29/2020] [Indexed: 11/07/2022]
Abstract
AIMS In infants with chronic neonatal lung disease (CNLD), we aimed to identify predictors of home oxygen duration, predictors of discharge oxygen flow rates, and the association of oxygen flow rates with respiratory outcomes. METHODS Infants with CNLD requiring home oxygen in 2016 and 2017 were retrospectively reviewed. Hazard ratios (HR) were estimated from Cox proportional hazards regression models in the cohort. A multinomial logistic regression model examined the effects of maternal and infant variables on discharge oxygen flow rates. Kruskal-Wallis test with univariate linear regression and Fisher's exact test with binomial univariate logistic regression were used to examine associations between oxygen flow groups and post-discharge clinical variables. RESULTS One hundred and forty-nine infants were included. Median corrected gestational age (CGA) at oxygen cessation was 6.8 months (interquartile range, 4.4) with 87.2% of infants weaned by 12 months CGA. Shorter initial neonatal intensive care unit (NICU) stay predicted faster oxygen weaning at 9 months (HR, 0.99; 95% confidence interval [CI], 0.98-1.00, p = .02) and 12 months (HR, 0.99; 95% CI, 0.98-1.00, p = .02). Infants with hypercarbia at discharge or discharged from NICU at higher CGA had higher odds of requiring ≥ 200 ml/min relative to ≤ 125 ml/min oxygen. Infants discharged with > 250 ml/min oxygen were more likely to have a respiratory-related admission before 2 years chronological age. CONCLUSION Shorter initial NICU stay was the best predictor of earlier home oxygen cessation. At NICU discharge, infants with hypercarbia or a higher CGA may require more home oxygen and experience more respiratory-related hospital admission in the first 2 years of chronological age.
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Affiliation(s)
- Matthew D Wong
- Pediatric Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Melissa Neylan
- Pediatric Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Gordon Williams
- Pediatric Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Syeda F Zahir
- QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Jasneek Chawla
- Pediatric Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
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