Cardiorespiratory Events in Infants Born Preterm during the Transitional Period

Abstract

To investigate the features of cardiorespiratory events in infants born preterm during the transitional period, and to evaluate whether different neonatal characteristics may correlate with event type, duration, and severity. Infants with gestational age (GA) <32weeks and/or birth weight <1500g were enrolled in this observational prospective study. Heart rate (HR) and peripheral oxygen saturation (SpO2) were recorded continuously over the first 72hours. Cardiorespiratory events of ≥10seconds were clustered into isolated desaturation (SpO2 <85%), isolated bradycardia (HR <100 bpm or <70% of baseline), or combined desaturation/bradycardia and classifiedas mild, moderate, or severe. The daily incidences of isolated desaturation, isolated bradycardia, and combined desaturation and bradycardia were analyzed. The effects of relevant clinical variables on cardiorespiratory event type and severity were assessed using generalized estimating equations. Among the 1050 events analyzed, isolated desaturations were the most frequent (n=625) and isolated bradycardias the least common (n=171). The number of cardiorespiratory events increased significantly from day 1 to day 2 (P=.028). One in 5 events had severe characteristics; event severity was highest for combined desaturation and bradycardia (P<.001). Compared with other event types, the incidence of combined desaturation and bradycardia was inversely correlated with GA (P=.029) and was higher with the use of continuous positive airway pressure (P=.002). The presence of a hemodynamically significant patent ductus arteriosus was associated with the occurrence of isolated desaturations (P=.001) and with a longer duration of cardiorespiratory events (P=.003). Cardiorespiratory events during transition exhibit distinct types, duration, and severity. Neonatal characteristics are associated with the clinical features of these events, indicating that a tailored clinical approach may reduce the hypoxic burden in preterm infants aged 0-72hours.