Ventilatory responses to rebreathing in infants exposed to maternal smoking

Abstract

This study assessed the effect of maternal smoking during pregnancy on ventilatory and waking responses of infants to a respiratory challenge. This challenge mimicked the time-course and concentration of gases that an infant would experience rebreathing face-down into soft bedding. Control (C; n = 97) and smokers' infants (SM; n = 96) were studied at ages I and 3 mo. Asphyxial gas (hypercapnia/hypoxia) was delivered to the supine sleeping baby via a hood by slowly altering the inspired air: CO2 maximum 5% and O2 minimum 13.5%. Respiratory pattern was recorded by inductive plethysmography as the sum of ribcage and abdominal movements. The change in ventilation with inspired CO2 was measured over 5-6 min of the test. The slope of a linear curve fit relating inspired CO2 to the logarithm of ventilation was taken as a quantitative measure of ventilatory asphyxial sensitivity (VAS). Protective responses were graded from 1: no waking and an estimated arterial carbon dioxide tension (PaCO2) > or = 60 mmHg (least protective), to 4: fully awake (most protective). The results showed VAS was higher in SM infants than controls: +0.03 (p = 0.04). The oxygen saturation (SaO2) of SM infants fell -0.4% (p = 0.02) more than SaO2 of controls despite a greater tidal volume increase: +13.0% (p = 0.04). Overall protective responses were the same between groups, but grade 1, although rare, was found in 7 SM infants and only 4 control infants; this difference was not significant. The study did not confirm the postulate that infants of mothers who smoked during pregnancy have a reduced ventilatory response or raised waking thresholds.