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Physiological instability after respiratory pauses in preterm infants


Marshall, AP and Lim, K and Ali, SK and Gale, TJ and Dargaville, PA, Physiological instability after respiratory pauses in preterm infants, Pediatric Pulmonology, 54, (11) pp. 1712-1721. ISSN 8755-6863 (2019) [Refereed Article]

Copyright Statement

Copyright 2019 Wiley Periodicals, Inc.

DOI: doi:10.1002/ppul.24451


Background: The factors influencing the severity of apnea-related hypoxemia and bradycardia are incompletely characterized, especially in infants receiving noninvasive respiratory support.

Objectives: To identify the frequency and predictors of physiological instability (hypoxemia-oxygen saturation (SpO2) <80%, or bradycardia-heart rate (HR) < 100 bpm) following respiratory pauses in infants receiving noninvasive respiratory support.

Methods: Respiratory pause duration, derived from capsule pneumography, was measured in 30 preterm infants of gestation 30 (24-32) weeks [median (interquartile range)] receiving noninvasive respiratory support and supplemental oxygen. For identified pauses of 5 to 29 seconds duration, we measured the magnitude and duration of SpO2 and HR reductions over a period starting at the pause onset and ending 60 seconds after resumption of breathing. Temporally clustered pauses (<60 seconds separation) were analyzed separately. The relative contribution of respiratory pauses to overall physiological instability was determined, and predictors of instability were sought in regression analysis, including demographic, clinical and situational variables as inputs.

Results: In total, 17 105 isolated and 9180 clustered pauses were identified. Hypoxemia and bradycardia were more likely after longer duration and temporally-clustered pauses. However, the majority of such episodes occurred after 5 to 9 second pauses given their numerical preponderance, and short-lived pauses made a substantial contribution to physiological instability overall. Birth gestation, hemoglobin concentration, form of respiratory support, caffeine treatment, respiratory pause duration and temporal clustering were identified as predictors of instability.

Conclusions: Brief respiratory pauses, especially when clustered, contribute substantially to hypoxemia and bradycardia in preterm infants.

Item Details

Item Type:Refereed Article
Keywords:apnea, bradycardia, hyperoxemia, hypoxemia
Research Division:Biomedical and Clinical Sciences
Research Group:Paediatrics
Research Field:Paediatrics not elsewhere classified
Objective Division:Health
Objective Group:Specific population health (excl. Indigenous health)
Objective Field:Neonatal and child health
UTAS Author:Marshall, AP (Mr Andrew Marshall)
UTAS Author:Gale, TJ (Dr Timothy Gale)
UTAS Author:Dargaville, PA (Professor Peter Dargaville)
ID Code:134059
Year Published:2019
Web of Science® Times Cited:5
Deposited By:Menzies Institute for Medical Research
Deposited On:2019-07-24
Last Modified:2020-09-04

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