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January 1990, Vol 144, No. 1 >
Article | January 1990

Apnea, Transient Episodes of Bradycardia, and Periodic Breathing in Preterm Infants FREE

Joan E. Hodgman, MD; Felipe Gonzalez, MD; Toke Hoppenbrouwers, PhD; Luis A. Cabal, MD
[+] Author Affiliations

Accepted for publication March 9, 1989.

Reprint requests to LAC/USC Medical Center, Women's Hospital, Room L-919, 1240 N Mission Rd, Los Angeles, CA 90033 (Dr Hodgman).


Am J Dis Child. 1990;144(1):54-57. doi:10.1001/archpedi.1990.02150250064032.
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• The occurrence of central apnea of 15 seconds or longer, transient episodes of bradycardia (TEB), and periodic breathing were studied in 66 healthy premature infants when at least 1 week old and between 32 and 36 weeks postconceptual age. Eight-hour cardiorespiratory recordings were visually scanned for the presence of thesee patterns. Central apnea of 15 seconds or longer was seen in almost half of the infants. The TEB were numerous, and the majority were not associated with central apnea; however, all but five of the apneic episodes that lasted 15 seconds or longer were accompanied by a TEB. Infants spent as much as 40% of their time in periodic breathing. The frequency with which these patterns are seen in healthy premature infants strongly suggests that they are normal findings. Our results do not support the opinion that brief periods of apnea are abnormal when accompanied by a TEB.

(AJDC. 1990;144:54-57)

REFERENCES

1 +
Miller HC, Behrle FC, Smull NW.  Severe apnea and irregular respiratory rhythms among premature infants . Pediatrics . 1959;;23:676-685.
2 +
Boutourline-Young JH, Smith CA.  Respiration of full term and of premature infants . AJDC . 1950;;80:753.
3 +
Church SC, Morgan BC, Oliver TKJr, Guntheroth WG.  Cardiac arrhythmias in premature infants: an indication of autonomic immaturity? J Pediatr . 1967;;71:542-546.
4 +
Daily WJR, Klaus M, Meyer HBP.  Apnea in premature infants: monitoring, incidence, heart rate changes, and an effect of environmental temperature . Pediatrics . 1969;;43:510-518.
5 +
Chernick V, Heldrich F, Avery ME.  Periodic breathing of premature infants . J Pediatr . 1964;; 64:330-340.
6 +
Fenner A, Schalk U, Hoenicke H, Wendenburg A, Roehling T.  Periodic breathing in premature and neonatal babies: incidence, breathing pattern, respiratory gas tensions, response to changes in the composition of ambient air . Pediatr Res . 1973;;7:174-183.
7 +
Parmelee AH, Sterm E, Harris MA.  Maturation of respiration in prematures and young infants . Neuropaediatrie . 1972;;3:294-304.
8 +
Gabriel M, Albani M, Schulte FJ.  Apnea spells and sleep states in preterm infants . Pediatrics . 1976;;57:142-147.
9 +
Krauss AN, Solomon GE, Auld PAM.  Sleep state, apnea and bradycardia in pre-term infants . Dev Med Child Neurol . 1977;;19:160-168.
10 +
Southall DP, Richards J, Brown DJ, Johnston PGB, De Swiet M, Shinebourne EA.  Twentyfour-hour tape recordings of ECG and respiration in the newborn infant with findings related to sudden death and unexplained brain damage in infancy . Arch Dis Child . 1980;;55:7-16.
11 +
Hendedrson-Smart DJ.  The effect of gestational age on the incidence and duration of recurrent apnea in newborn babies . Aust Paediatr J . 1981;;17:273-276.
12 +
Dubowitz L, Dubowitz V, Goldberg C.  Clinical assessment of gestational age in the newborn infant . J Pediatr . 1970;;77:1.
13 +
Sweet AY.  Classification of the low-birth-weight infant . In: Klaus MH, Fanaroff AA, eds. Care of the High-Risk Neonate . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1979;:chap 4.
14 +
Hoppenbrouwers T.  Electronic monitoring in the newborn and young infant: theoretical considerations . In: Guilleminault C, ed. Sleeping and Waking Disorders, Indications and Techniques . Reading, Mass: Addison-Wesley Publishing Co; 1982;:17-59.
15 +
Urbach JR, Phuvichit B, Zweizig H, et al.  Instantaneous heart rate patterns in newborn infants . Am J Obstet Gynecol . 1963;;93:965-974.
16 +
Schifrin BS.  Fetal heart rate monitoring during labor . JAMA . 1972;;222:196-202.
17 +
Henderson-Smart DJ.  Incidence and mechanism of bradycardia during apnea in preterm infants . Arch Dis Child . 1986;;61:227-232.
18 +
Valimaki I, Tarlo PA.  Heart rate patterns and apnea in newborn infants . Am J Obstet Gynecol . 1971;;110:343-349.
19 +
Vyas H, Milner AD, Hopkin IE.  Relationship between apnea and bradycardia in preterm infants . Acta Paediatr Scand . 1981;;70:785-790.
20 +
Smith ML, Milner AD.  Bradycardia and associated respiratory changes in neonates . Arch Dis Child . 1981;;156:645-648.
21 +
Milner AD, Boon AW, Saunders RA, Hopkin IE.  Upper airways obstruction and apnea in preterm babies . Arch Dis Child . 1980;;55:22-25.
22 +
Dransfield DA, Spitzer AR, Fox WW.  Episodic airway obstruction in premature infants . AJDC . 1983;;137:441-443.
23 +
Thach BT, Stark AR.  Spontaneous neck flexion and airway obstruction during apneic spells in preterm infants . J Pediatr . 1979;;94:275-281.
24 +
Van Someren V, Stothers JK.  A critical dissection of obstructive apnea in the human infant . Pediatrics . 1983;;71:721-725.
25 +
Rigatto H, Brady JP.  Periodic breathing and apnea in preterm infants, I: Evidence for hypoventilation possibly due to central respiratory depression . Pediatrics . 1972;;50:202-218.
26 +
Curzi-Dascalova L, Christova-Gueorguieva E.  Respiratory pauses in normal prematurely born infants . Biol Neonate . 1983;;44:325-332.
27 +
Phillips SJ, Agate FJ, Silverman WA, Steiner P.  Autonomic cardiac reactivity in premature infants . Biol Neonate . 1964;;6:225-249.
28 +
Hiatt IM, Hegyi T, Indyk L, et al.  Continuous monitoring of PO2 during apnea of prematurity . J Pediatr . 1981;;98:288-291.
29 +
Kattwinkel J, Fanaroff AA, Klaus MH.  Bradycardia in preterm infants: indications and hazards of atropine therapy . Pediatrics . 1976;;58:494-499.
30 +
Cabal LA, Devaskar S, Siassi B, et al.  New endotracheal tube adaptor reducing cardiopulmonary effects of suctioning . Crit Care Med . 1979;; 7:552-559.
31 +
Perlman JM, Volpe JJ.  Episodes of apnea and bradycardia in the preterm newborn: impact on cerebral circulation . Pediatrics . 1985;;76:333-338.
32 +
Cabal L, Siassi B, Plajstek C, Lewis D, Hodgman JE.  Transient Po2 and Pco2 obtained by a single dual probe in newborn infants . Pediatr Res . 1984;;18:387A.
33 +
Rigatto H, Brady JP.  Periodic breathing and apnea in preterm infants, II: Hypoxia as a primary event . Pediatrics . 1972;;50:219-228.
34 +
Butcher-Puech MC, Henderson-Smart DJ, Holley D, et al.  Relationship between apnea duration and type and neurological status of preterm infants . Arch Dis Child . 1985;;60:953-958.
35 +
National Institutes of Health. Infantile Apnea and Home Monitoring . Washington, DC: National Institute of Child Health and Human Development; September 1987;. Consensus Development, Conference Statement. US Dept of Health, Education, and Welfare publication NIH 87-2905.
36 +
American Academy of Pediatrics Task Force on prolonged infant apnea. Pediatrics . 1985;;76:129-131.
37 +
Patz A.  The role of oxygen in retrolental fibroplasia: E. Mead Johnson award address . Pediatrics . 1957;;19:504-524.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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References

1 +
Miller HC, Behrle FC, Smull NW.  Severe apnea and irregular respiratory rhythms among premature infants . Pediatrics . 1959;;23:676-685.
2 +
Boutourline-Young JH, Smith CA.  Respiration of full term and of premature infants . AJDC . 1950;;80:753.
3 +
Church SC, Morgan BC, Oliver TKJr, Guntheroth WG.  Cardiac arrhythmias in premature infants: an indication of autonomic immaturity? J Pediatr . 1967;;71:542-546.
4 +
Daily WJR, Klaus M, Meyer HBP.  Apnea in premature infants: monitoring, incidence, heart rate changes, and an effect of environmental temperature . Pediatrics . 1969;;43:510-518.
5 +
Chernick V, Heldrich F, Avery ME.  Periodic breathing of premature infants . J Pediatr . 1964;; 64:330-340.
6 +
Fenner A, Schalk U, Hoenicke H, Wendenburg A, Roehling T.  Periodic breathing in premature and neonatal babies: incidence, breathing pattern, respiratory gas tensions, response to changes in the composition of ambient air . Pediatr Res . 1973;;7:174-183.
7 +
Parmelee AH, Sterm E, Harris MA.  Maturation of respiration in prematures and young infants . Neuropaediatrie . 1972;;3:294-304.
8 +
Gabriel M, Albani M, Schulte FJ.  Apnea spells and sleep states in preterm infants . Pediatrics . 1976;;57:142-147.
9 +
Krauss AN, Solomon GE, Auld PAM.  Sleep state, apnea and bradycardia in pre-term infants . Dev Med Child Neurol . 1977;;19:160-168.
10 +
Southall DP, Richards J, Brown DJ, Johnston PGB, De Swiet M, Shinebourne EA.  Twentyfour-hour tape recordings of ECG and respiration in the newborn infant with findings related to sudden death and unexplained brain damage in infancy . Arch Dis Child . 1980;;55:7-16.
11 +
Hendedrson-Smart DJ.  The effect of gestational age on the incidence and duration of recurrent apnea in newborn babies . Aust Paediatr J . 1981;;17:273-276.
12 +
Dubowitz L, Dubowitz V, Goldberg C.  Clinical assessment of gestational age in the newborn infant . J Pediatr . 1970;;77:1.
13 +
Sweet AY.  Classification of the low-birth-weight infant . In: Klaus MH, Fanaroff AA, eds. Care of the High-Risk Neonate . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1979;:chap 4.
14 +
Hoppenbrouwers T.  Electronic monitoring in the newborn and young infant: theoretical considerations . In: Guilleminault C, ed. Sleeping and Waking Disorders, Indications and Techniques . Reading, Mass: Addison-Wesley Publishing Co; 1982;:17-59.
15 +
Urbach JR, Phuvichit B, Zweizig H, et al.  Instantaneous heart rate patterns in newborn infants . Am J Obstet Gynecol . 1963;;93:965-974.
16 +
Schifrin BS.  Fetal heart rate monitoring during labor . JAMA . 1972;;222:196-202.
17 +
Henderson-Smart DJ.  Incidence and mechanism of bradycardia during apnea in preterm infants . Arch Dis Child . 1986;;61:227-232.
18 +
Valimaki I, Tarlo PA.  Heart rate patterns and apnea in newborn infants . Am J Obstet Gynecol . 1971;;110:343-349.
19 +
Vyas H, Milner AD, Hopkin IE.  Relationship between apnea and bradycardia in preterm infants . Acta Paediatr Scand . 1981;;70:785-790.
20 +
Smith ML, Milner AD.  Bradycardia and associated respiratory changes in neonates . Arch Dis Child . 1981;;156:645-648.
21 +
Milner AD, Boon AW, Saunders RA, Hopkin IE.  Upper airways obstruction and apnea in preterm babies . Arch Dis Child . 1980;;55:22-25.
22 +
Dransfield DA, Spitzer AR, Fox WW.  Episodic airway obstruction in premature infants . AJDC . 1983;;137:441-443.
23 +
Thach BT, Stark AR.  Spontaneous neck flexion and airway obstruction during apneic spells in preterm infants . J Pediatr . 1979;;94:275-281.
24 +
Van Someren V, Stothers JK.  A critical dissection of obstructive apnea in the human infant . Pediatrics . 1983;;71:721-725.
25 +
Rigatto H, Brady JP.  Periodic breathing and apnea in preterm infants, I: Evidence for hypoventilation possibly due to central respiratory depression . Pediatrics . 1972;;50:202-218.
26 +
Curzi-Dascalova L, Christova-Gueorguieva E.  Respiratory pauses in normal prematurely born infants . Biol Neonate . 1983;;44:325-332.
27 +
Phillips SJ, Agate FJ, Silverman WA, Steiner P.  Autonomic cardiac reactivity in premature infants . Biol Neonate . 1964;;6:225-249.
28 +
Hiatt IM, Hegyi T, Indyk L, et al.  Continuous monitoring of PO2 during apnea of prematurity . J Pediatr . 1981;;98:288-291.
29 +
Kattwinkel J, Fanaroff AA, Klaus MH.  Bradycardia in preterm infants: indications and hazards of atropine therapy . Pediatrics . 1976;;58:494-499.
30 +
Cabal LA, Devaskar S, Siassi B, et al.  New endotracheal tube adaptor reducing cardiopulmonary effects of suctioning . Crit Care Med . 1979;; 7:552-559.
31 +
Perlman JM, Volpe JJ.  Episodes of apnea and bradycardia in the preterm newborn: impact on cerebral circulation . Pediatrics . 1985;;76:333-338.
32 +
Cabal L, Siassi B, Plajstek C, Lewis D, Hodgman JE.  Transient Po2 and Pco2 obtained by a single dual probe in newborn infants . Pediatr Res . 1984;;18:387A.
33 +
Rigatto H, Brady JP.  Periodic breathing and apnea in preterm infants, II: Hypoxia as a primary event . Pediatrics . 1972;;50:219-228.
34 +
Butcher-Puech MC, Henderson-Smart DJ, Holley D, et al.  Relationship between apnea duration and type and neurological status of preterm infants . Arch Dis Child . 1985;;60:953-958.
35 +
National Institutes of Health. Infantile Apnea and Home Monitoring . Washington, DC: National Institute of Child Health and Human Development; September 1987;. Consensus Development, Conference Statement. US Dept of Health, Education, and Welfare publication NIH 87-2905.
36 +
American Academy of Pediatrics Task Force on prolonged infant apnea. Pediatrics . 1985;;76:129-131.
37 +
Patz A.  The role of oxygen in retrolental fibroplasia: E. Mead Johnson award address . Pediatrics . 1957;;19:504-524.

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