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Zannin E, Stoecklin B, Choi JY, Simpson SJ, Veneroni C, Dellaca RL, Pillow JJ. Ventilatory response and stability of oxygen saturation during a hypoxic challenge in very preterm infants. Pediatr Pulmonol 2023; 58:1454-1462. [PMID: 36748837 DOI: 10.1002/ppul.26343] [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: 11/02/2022] [Revised: 01/17/2023] [Accepted: 02/05/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Preterm infants have immature control of breathing and impaired pulmonary gas exchange. We hypothesized that infants with bronchopulmonary dysplasia (BPD) have a blunted ventilatory response and peripheral oxygen saturation (SpO2 ) instability during a hypoxic challenge. METHODS We evaluated the response to hypoxia in 57 very preterm infants (38 no BPD, 10 mild BPD, 9 moderate-to-severe BPD) at 36 weeks' postmenstrual age. The fraction of inspired oxygen (FI O2 ) was reduced stepwise at 5-min intervals to achieve peripheral SpO2 between 86% and 95%. The lowest permissible FI O2 and SpO2 were 0.14% and 86%. We recorded SpO2 , FI O2 , and the respiratory signal (respiratory inductive plethysmography). We calculated respiratory rate (RR), tidal volume (VT ), minute ventilation (VE ), and respiratory drive (ratio between VT and inspiratory time, VT /TI ). SpO2 variability was expressed as the interquartile range (IQR). RESULTS FI O2 was reduced from a median (Q1, Q3) of 0.21 (0.21, 0.21) to 0.17 (0.17, 0.18). We observed a marked individual variability in the ventilatory response to the hypoxic challenge, regardless of BPD severity. At the lowest permissible FI O2 , 37 (65%) infants reduced their VE , and 20 (35%) increased minute ventilation; 20 infants (35%) developed periodic breathing associated with increased SpO2 IQR and lower SpO2 minima, and 16 (28%) exhibited an oscillatory pattern in VE and SpO2 without end-expiratory pauses, regardless of BPD severity. CONCLUSION In very preterm infants, a mild hypoxic challenge reduced ventilation, increased SpO2 variability and periodic breathing regardless of BPD severity.
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Affiliation(s)
- Emanuela Zannin
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.,Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Benjamin Stoecklin
- School of Human Sciences, University of Western Australia, Perth, Australia.,Department of Neonatology, Children's Lung Health, University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Jane Y Choi
- School of Human Sciences, University of Western Australia, Perth, Australia.,Children's Lung Health, Wal-yan Respiratory Centre, Telethon Kids Institute, Perth, Australia
| | - Shannon J Simpson
- Children's Lung Health, Wal-yan Respiratory Centre, Telethon Kids Institute, Perth, Australia.,School of Physiotherapy and Exercise Science, Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Chiara Veneroni
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Raffaele L Dellaca
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Jane J Pillow
- School of Human Sciences, University of Western Australia, Perth, Australia.,Children's Lung Health, Wal-yan Respiratory Centre, Telethon Kids Institute, Perth, Australia
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Mammel D, Kemp J. Prematurity, the diagnosis of bronchopulmonary dysplasia, and maturation of ventilatory control. Pediatr Pulmonol 2021; 56:3533-3545. [PMID: 34042316 DOI: 10.1002/ppul.25519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/27/2021] [Accepted: 05/03/2021] [Indexed: 11/10/2022]
Abstract
Infants born before 32 weeks gestational age and receiving respiratory support at 36 weeks postmenstrual age (PMA) are diagnosed with bronchopulmonary dysplasia (BPD). This label suggests that their need for supplemental oxygen (O2 ) is primarily due to acquired dysplasia of airways and airspaces, and that the supplemental O2 is treating residual parenchymal lung disease. However, emerging evidence suggests that immature ventilatory control may also contribute to the need for supplemental O2 at 36 weeks PMA. In all newborns, maturation of ventilatory control continues ex utero and is a plastic process. Among premature infants, supplemental O2 mitigates the hypoxemic effects of delayed maturation of ventilatory control, as well as reduces the duration and frequency of periodic breathing events. Nevertheless, prematurity is associated with altered and occasionally aberrant maturation of ventilatory control. Infants born prematurely, with or without a diagnosis of BPD, are more prone to long-lasting effects of dysfunctional ventilatory control. This review addresses normal and abnormal maturation of ventilatory control and suggests how aberrant maturation complicates assigning the diagnosis of BPD. Greater awareness of the interaction between parenchymal lung disease and delayed maturation of ventilatory control is essential to understanding why a given premature infant requires and is benefitting from supplemental O2 at 36 weeks PMA.
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Affiliation(s)
- Daniel Mammel
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine in Saint Louis, St. Louis, Missouri, USA
| | - James Kemp
- Department of Pediatrics, Allergy and Pulmonary Medicine, Division of Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine in Saint Louis, St. Louis, Missouri, USA
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