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Pathophysiology of Sleep-Disordered Breathing in Children and Neonates
Published in Susmita Chowdhuri, M Safwan Badr, James A Rowley, Control of Breathing during Sleep, 2022
Sofia Konstantinopoulou, Ignacio E Tapia
Apnea of prematurity is a well-described condition related to immaturity of the central and autonomic nervous systems and neurotransmitter systems (4). The incidence of apnea is inversely related with the gestational age with the highest incidence occurring in infants <28 weeks of gestation. Apnea may also persist beyond 40 weeks of postmenstrual age in infants born <28 weeks of gestation (5). Physiologic contributors include a blunted ventilatory response to oxygen and carbon dioxide, compromised lung volumes, and small airways that are prone to collapse and obstruction. Apnea of prematurity results from a number of influences (intrinsic and extrinsic) affecting the central respiratory network, the peripheral and central chemoreceptors and the mechanoreceptors, and ultimately leads to a reduction in output to the muscles of respiration. The chest wall and soft tissues of the upper airway, both of which are quite compliant in premature infants, predispose to upper and lower airway collapse and obstruction (6).
Neonatal diseases I
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Apnea of prematurity is a condition frequently seen in preterm infants. It is defined as a cessation in breathing for more than 20 seconds, or less than 20 seconds if it is associated with bradycardia and/or cyanosis (1). The incidence of this disorder increases with decreasing gestational age, but luckily most infants outgrow this disorder by the time they reach 35 to 36 weeks postconceptional age. Over the last 20 years, the prevalence of this disorder has increased as smaller, more preterm infants are now surviving. With advances in ventilator management and surfactant therapy, many preterm infants are currently being extubated within days of admission to the neonatal intensive care unit. The goal is to keep them off the ventilators to prevent potential trauma to the developing lungs. As a result, neonatologists are faced with a dilemma about when is the frequency of apnea high enough to require reintubation.
Four-Handed Method Improves Neonates’ Comfort During Suctioning
Published in Teuku Tahlil, Hajjul Kamil, Asniar, Marthoenis, Challenges in Nursing Education and Research, 2020
Breathing often occurs in infants with a gestational age of less than 37 weeks. Committee on Fetus and Newborn (2003 in Weiss & Tolomeo, 2012) states that significant apnea in infants is stopping breathing for more than 20 seconds or more than 10 seconds accompanied by bradycardia or desaturation <80–85%. Apnea of prematurity occurs in more than 50% of premature babies and the majority in infants weighing less than 1000 grams (Alden et al., 1972 in Weiss & Tolomeo, 2012).
The prevention and management strategies for neonatal chronic lung disease
Published in Expert Review of Respiratory Medicine, 2023
Christopher Harris, Anne Greenough
Caffeine acts by increasing central respiratory drive stimulating diaphragmatic contractility has a diuretic action [87] and has anti-inflammatory properties [88,89]. In the Caffeine for Apnea of Prematurity (CAP) trial, infants were randomized if methylxanthines were thought to be required for prevention or treatment of apnea and/or facilitation of removal of an endotracheal tube in the first 10 days after birth. The primary outcome of death or neurodevelopmental disability (NDI) determined at 18 to 21 months was significantly lower in the caffeine group who also had a lower BPD rate [90]. Caffeine use was associated with a lower PDA incidence [91], which may in part have been responsible for the reduction in BPD. Early initiation of caffeine therapy was associated with a greater reduction in ventilation duration [92].
Clinical considerations when treating neonatal aspiration syndromes
Published in Expert Review of Respiratory Medicine, 2019
Andrea Calkovska, Daniela Mokra, Vladimir Calkovsky, Katarina Matasova, Mirko Zibolen
In a mature organism, LCR trigger lower airway protective responses: arousal, swallowing, and laryngeal closure [18]. Coughing as a component of LCR is very rare in neonates and its occurrence increases with maturation [17]. These aspects of LCR are aimed at clearing liquids from the pharyngeal airway adjacent to the larynx and preventing tracheal-bronchial aspiration by vocal cord constriction, combined with apnea. With maturation, apnea and swallowing incidents are reduced, while coughing becomes more prominent. LCR in the immature newborn include central or mixed apneas, among other reflexes, and are observed in response to pooling of salivary or respiratory secretions, gastroesophageal reflux, and feeding [17]. In contrast to full-term infants, preterm neonates show more prolonged responses with repetitive swallows, apnea, or sustained laryngospasm, which interrupts pulmonary ventilation and causes hypoxia [19]. LCR has been extensively studied, mainly in relation to apnea due to prematurity [20]. On the one hand, active glottal closure throughout central apneas can be beneficial in relation to inspiratory breath-holding. It can minimize aspiration of secretions, which may have accumulated in the hypopharynx during apnea [20]. On the other hand, stimulation of the pharyngeal region from accumulated secretions, as well as regurgitated gastric content by eliciting LCR, can be a significant cause of apnea from prematurity [3].