Apnea In Preterm Infants Research Articles

The effect of vibrotactile stimulation on hypoxia-induced irregular breathing and apnea in preterm rabbits.

Manual tactile stimulation is used to counteract apnea in preterm infants, but it is unknown when this intervention should be applied. We compared an anticipatory to a reactive approach using vibrotactile stimulation to prevent hypoxia induced apneas. Preterm rabbit kittens were prematurely delivered and randomized to either group. All kittens breathed spontaneously with a positive airway pressure of 8 cmH2O while they were imaged using phase contrast X-ray. Irregular breathing (IB) was induced using gradual hypoxia. The anticipatory group received stimulation at the onset of IB and the reactive group if IB transitioned into apnea. Breathing rate (BR), heart rate (HR) and functional residual capacity (FRC) were compared. Anticipatory stimulation significantly reduced apnea incidence and maximum inter-breath intervals and increased BR following IB, compared to reactive stimulation. Recovery in BR but not HR was more likely with anticipatory stimulation, although both BR and HR were significantly higher at 120 s after stimulation onset. FRC values and variability were not different. Anticipated vibrotactile stimulation is more effective in preventing apnea and enhancing breathing when compared to reactive stimulation in preterm rabbits. Stimulation timing is likely to be a key factor in reducing the incidence and duration of apnea. Anticipated vibrotactile stimulation can prevent apnea and stimulate breathing effort in preterm rabbits. Anticipated vibrotactile stimulation increases the likelihood of breathing rate recovery following hypoxia induced irregular breathing, when compared to reactive stimulation. Automated stimulation in combination with predictive algorithms may improve the treatment of apnea in preterm infants.

Intrathecal levo-bupivacaine versus hyperbaric bupivacaine for inguinal hernia repairs in ex-preterm infants: A double blinded randomized prospective study

ABSTRACT Background and aim The anesthetic management of premature neonates has many challenges resulting from immature physiological adaptations, the transitional circulation, increased presence of comorbidities and, prominently, the occurrence of apnea in preterm infants. The aim of the present study was to compare the efficacy and safety of levobupivacaine with hyperbaric bupivacaine for spinal anesthesia in preterm infants scheduled for inguinal hernia repair. Methods A double-blinded randomized, prospective, controlled study was conducted in a tertiary care pediatric surgery center from January 2017 to February 2021 where 60 preterm infants aged <45 weeks post-menstrual age (PMA) were scheduled for an elective inguinal hernia repair procedure. Preterm infants comforted by a sugared pacifier were divided randomly into two groups (30 infants each). Group I received spinal anesthesia with 1 mg/kg 0.5% hyperbaric bupivacaine, while group II received spinal anesthesia with1mg/kg o.5% levo-bupivacaine. The primary objective was to assess the hemodynamic stability, sensory and motor blockade of intrathecal levo-bupivacaine compared to hyperbaric bupivacaine in premature infants, and secondarily was to monitor the incidence of postoperative apnea, length of stay (LOS), and need for postoperative ventilator support. Results The onset of sensory block of spinal anesthesia in group II was statistically significantly faster than in group I (Group I = 2.6 ± 0.52 min, Group II = 2.3 ± 0.35 min, p = 0.0112), with a statistically significant rapid regression in group II compared to group I (group I = 86 ± 2.45 min, Group II = 84 ± 3.67 min, p = 0.016). Conclusions Levo-bupivacaine is an effective and safe agent for spinal anesthesia and has an equivalent potency to hyperbaric bupivacaine for motor blockade in premature infants requiring inguinal hernia repair surgery.

Doxapram for the prevention and treatment of apnea in preterm infants.

Doxapram for the prevention and treatment of apnea in preterm infants.

Caffeine versus other methylxanthines for the prevention and treatment of apnea in preterm infants.

Caffeine versus other methylxanthines for the prevention and treatment of apnea in preterm infants.

Caffeine and neonatal acute kidney injury.

Acute kidney injury is one of the most threatening diseases in neonates, with complex pathogenesis and limited treatment options. Caffeine is a commonly used central nervous system stimulant for treating apnea in preterm infants. There is compelling evidence that caffeine may have potential benefits for preventing neonatal acute kidney injury, but comprehensive reports are lacking in this area. Hence, this review aims to provide a summary of clinical data on the potential benefits of caffeine in improving neonatal acute kidney injury. Additionally, it delves into the molecular mechanisms underlying caffeine's effects on acute kidney injury, with a focus on various aspects such as oxidative stress, adenosine receptors, mitochondrial dysfunction, endoplasmic reticulum stress, inflammasome, autophagy, p53, and gut microbiota. The ultimate goal of this review is to provide information for healthcare professionals regarding the link between caffeine and neonatal acute kidney injury and to identify gaps in our current understanding.

Phenotypical Characterization of Obstructive Sleep Apnea in Premature Infants using Polysomnography.

To use objective quantification of polysomnographic (PSG) parameters in premature infants to define the severity and nature of obstructions (partial hypopnea vs. total obstruction), along with the impact on sleep fragmentation and oxygenation patterns. Retrospective comparison of PSG features in 207 infants (<12 months) referred for sleep disordered breathing. Our study groups included term (> = 37 weeks GA, n = 162) and premature (<37 weeks GA, n = 45) infants. Groups were compared for OSA sleep-stage-specific apnea hypopnea (AHI) indexes (REM and NREM), hypopnea indexes (HI), obstructive apnea indexes (OI) and arousal indexes. Oxygenation was assessed as % of time with SpO2 < 90%, nadir with apneic events and frequency of SpO2 desaturations (>3%) calculated as stage-specific O2 desaturation indexes. Overall, premature infants had greater apnea severity (AHI premature 13.9/h vs. Term 7.9/h, p = 0.018). Additional analyses showed that the primary difference between premature and term infants is seen in the group with partial obstructions (HI index) and severe OSA (OAHI> = 10/h). Premature infants also had greater arousal indexes (premature 13.8/h vs. term 10.5/h, p = 0.003). Although the percentage of time <90% at night and the median SpO2 nadir during apneic events was similar in premature vs. term, O2 desaturation indexes were greater in premature infants (10.3/h in term vs. 18.3/h in prematurity, p = 0.03). Children born premature have an OSA phenotype in infancy characterized by greater severity mostly due to frequent partial obstructions (hypopneas) rather than full obstructions (obstructive apnea). Prematurity is also associated with more intermittent hypoxemia and sleep fragmentation. 3 Laryngoscope, 134:1933-1938, 2024.

Anesthetic Management in Preeclampsia Patients with Thalassemia Minor B: A Case Report

Introduction: One of the complications of anesthesia that can be encountered in thalassemia patients is cardiovascular instability caused by chronic anemia, cardiomyopathy, and endocrinopathy. In addition, patients with preeclampsia may also experience postoperative risks such as sustained hypertension, stroke, venous thromboembolism, and seizures. This case report will discuss the anesthetic management of pregnant women with preeclampsia and β thalassemia minor.&#x0D; Case presentation: The patient is a pregnant woman G6P0141, 34 weeks gestation, with preeclampsia and a history of minor β thalassemia without therapy. Patients with thalassemia minor are often asymptomatic before pregnancy, but physiological changes during pregnancy can contribute to anemia during pregnancy. Beta thalassemia minor is also associated with an increased incidence of hypertension in pregnancy. Neuraxial anesthesia is recommended in preeclamptic patients to avoid severe hypertension and has a protective effect against postoperative apnea in premature infants.&#x0D; Conclusion: Anesthetic management in asymptomatic patients with minor thalassemia is not much different from normal pregnant women. The risk of bleeding needs special attention, especially in thalassemia patients who have anemia. In patients with preeclampsia, neuraxial anesthesia is preferred over general anesthesia. Postoperative patient care is carried out in an obstetric high dependency unit (OHDU). The patient went home after being treated for 3 days without complications at the hospital.

Efficacy and Safety Evaluation of Different Maintenance Dose Regimens of Caffeine Citrate in the Treatment of Primary Apnea in Preterm Infants

We have investigated the efficacy and safety of different maintenance doses of caffeine citrate in the treatment of primary apnea in preterm infants. To this end, apneic premature infants were treated with 5 mg/kg (low dose) or 10 mg/kg (high dose) caffeine citrate, and the frequency of apnea at 48 h and 72 h, improvement of clinical symptoms, respiratory mechanics parameters related to lung function, and blood gas analysis indexes were compared between the two groups, and safety was evaluated. The frequency of apnea at 48 h and 72 h was significantly lower in the high-dose group than in the low-dose group, and the difference was statistically significant (P &lt; 0.05). The time to resolution of apnea, the time to mechanical ventilation, and the time to citrate use were significantly shorter in the high-dose group than in the low-dose group (P &lt; 0.05). The tidal volume and peak expiratory flow values were significantly higher in the high-dose group than in the low-dose group (P &lt; 0.05). The oxygen partial pressure and pulse oximetry levels in the blood gas analysis indexes of the high-dose group were significantly higher than those of the low-dose group, and the partial pressure of carbon dioxide level was significantly lower than that of the low-dose group, with statistically significant differences (P &lt; 0.05). The safety evaluation results showed no significant difference in the rate of adverse reactions and short-term complications between the high-dose group and the low-dose group (P &gt; 0.05). Caffeine citrate at a maintenance dose of 10 mg/kg can effectively reduce the frequency of apnea, shorten the improvement time of clinical symptoms, and improve the lung function and blood gas analysis level of children with a high safety profile.

The Effects of Aroma on Apnea Attacks and Oxygen Saturation Among Preterm Infants: A Systematic Review and Meta-Analysis:.

Researchers and clinicians need to be aware of procedures that are more adaptable to new and different environments in premature infants; therefore, it is important to conduct a comprehensive review of the effect of aromatherapy on apnea attacks and oxygen saturation (SpO2 ) in premature newborns. In this review, databases such as PubMed, Scopus, Web of Science, and Cochrane Library were systematically searched without language and time limitations up to November 1, 2022. Initially, 153 studies were founded, and after duplicate removal, title as well as full-text review, seven studies were enrolled in the final analysis. Studies indicated that aromatherapy with Rosa damascena, vanilla, and breast milk odors could significantly reduce apneas in preterm infants and improve SpO2 levels. Hence, aromatherapy could consider as an effective adjuvant treatment for the reduction of apnea attacks among preterm infants.

Caffeine versus other methylxanthines for the prevention and treatment of apnea in preterm infants

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of caffeine compared to aminophylline or theophylline in preterm infants at risk of apnea, with apnea, or in the peri‐extubation phase.

Molecular Mechanism of Caffeine in Preventing Bronchopulmonary Dysplasia in Premature Infants.

Bronchopulmonary dysplasia (BPD) is a chronic respiratory complication commonly seen in premature infants. Following continuous advances in neonatal intensive care diagnosis and treatment technology, an increasing number of premature babies are being treated successfully. Despite these remarkable improvements, there has been no significant decline in the incidence of BPD; in fact, its incidence has increased as more extremely preterm infants survive. Therefore, in view of the impact of BPD on the physical and mental health of children and the increased familial and social burden on these children, early prevention of BPD is emphasized. In recent decades, the clinical application of caffeine in treating primary apnea in premature infants was shown not only to stimulate the respiratory center but also to confer obvious protection to the nervous and respiratory systems. Numerous clinical cross-sectional and longitudinal studies have shown that caffeine plays a significant role in the prevention and treatment of BPD, but there is a lack of overall understanding of its potential molecular mechanisms. In this review, we summarize the possible molecular mechanisms of caffeine in the prevention or treatment of BPD, aiming to better guide its clinical application.

Doxapram for the prevention and treatment of apnea in preterm infants

Doxapram for the prevention and treatment of apnea in preterm infants

Caffeine disrupts ataxia telangiectasia mutated gene-related pathways and exacerbates acetaminophen toxicity in human fetal immortalized hepatocytes

Preterm infants are at greater risk for adverse drug effects due to hepatic immaturity. Multiple interventions during intensive care increases potential for drug interactions. In this setting, high-dose caffeine used for apnea in premature infants may increase acetaminophen toxicity by inhibiting ataxia telangiectasia mutated (ATM) gene activity during DNA damage response. To define caffeine and acetaminophen interaction, we modeled infantile prematurity in late-gestation fetal stage through human immortalized hepatocytes and liver organoids. The acute toxicity studies included assays for cell viability, mitochondrial dysfunction and ATM pathway-related DNA damage. Fetal cells expressed hepatobiliary properties, albeit with lower metabolic, synthetic and antioxidant functions than more mature hepatocytes. Acetaminophen in IC50 amount of 7.5 millimolar caused significant oxidative stress, mitochondrial membrane potential impairments, and DNA breaks requiring ATM-dependent repair. Caffeine markedly exacerbated acetaminophen toxicity by suppressing ATM activity in otherwise nontoxic 2.5 millimolar amount. Similarly, the specific ATM kinase antagonist, KU-60019, reproduced this deleterious interaction in 5 micromolar amount. Replicative stress from combined acetaminophen and caffeine toxicity depleted cells undergoing DNA synthesis in S phase and activated checkpoints for G0/G1 or G2/M restrictions. Synergistic caffeine and acetaminophen toxicity in liver organoids indicated these consequences should apply in vivo. The antioxidant, N-acetylcysteine, decreased oxidative damage, mitochondrial dysfunction and ATM pathway disruption to mitigate caffeine and acetaminophen toxicity. We concluded that hepatic DNA damage, mitochondrial impairment and growth-arrest after combined caffeine and acetaminophen toxicity will be harmful for premature infants. Whether caffeine and acetaminophen toxicity may alter outcomes in subsequently encountered hepatic disease needs consideration.

Prophylactic versus therapeutic caffeine for apnea of prematurity: a randomized controlled trial

Background Therapeutic initiation of methyxanthines for treatment of apnea in preterm infants was the standard policy. Caffeine therapy is beneficial for various outcomes of preterm infants. Aim To evaluate the efficacy of early prophylactic compared to routine therapeutic caffeine therapy on duration of oxygen support and other outcomes of preterm infants. Methods In a randomized controlled trial including preterm infants < 32 weeks’ gestation, prophylactic (in the first 72 h of life) versus therapeutic (only if apnea exists or infant requires mechanical ventilation) decision of caffeine was compared. The primary outcome was the duration of oxygen therapy. Secondary outcomes included duration of respiratory support modalities; bronchoplumonary dysplasia (BPD); necrotizing enterocolitis; intra-ventricular hemorrhage; retinopathy of prematurity; length of hospital stay (LOS); neonatal mortality; and caffeine side effects. Results We enrolled 90 infants in the prophylactic and 91 infants in therapeutic groups respectively. Prophylactic caffeine decreased the duration of oxygen therapy [median and IQR of 28 (18–36) days versus 34 (23–51) days, p = .005 respectively]. Prophylactic caffeine significantly decreased the durations of respiratory support modalities, LOS, and incidences of mild to moderate BPD without reported effects on the incidence of severe BPD or other clinical outcomes compared to therapeutic caffeine. A significantly higher proportion of infants in the prophylactic caffeine group did not require mechanical ventilation during their NICU admission and a significant lower proportion required late mechanical ventilation compared to the prophylactic caffeine group. Conclusion Prophylactic caffeine decreased the duration of oxygen therapy, invasive and noninvasive ventilation, incidences of mild to moderate BPD, and LOS in preterm infants.

Cerebral Oxygenation during Apnea in Preterm Infants: Effects of Accompanying Peripheral Oxygen Desaturation

Cerebral Oxygenation during Apnea in Preterm Infants: Effects of Accompanying Peripheral Oxygen Desaturation

Methylxanthine for the prevention and treatment of apnea in preterm infants

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the effects of methylxanthine administration on the incidence of apnea and longer‐term clinical outcomes in preterm infants including infants at risk for or having apnea and preterm infants peri‐extubation.

What are the effects of methylxanthine for prevention of apnea in preterm infants?

What are the effects of methylxanthine for prevention of apnea in preterm infants?

Anthropometry: A clue for Otorhinolaryngology surgical indications in children

BackgroundThere are reports in literature concerning the relation between some maternal and neonatal factors and future risk of disease, including atopy, recurrent infections and obstructive sleep disturbances, three common pathologies eliciting surgery in children. ObjectiveTo evaluate if maternal and neonatal factors can relate to Otorhinolaryngology surgical indications in a cohort of children treated in a tertiary referral center. Material and methodsA retrospective analysis of data from children submitted to primary Otorhinolaryngology surgery in the pediatric ambulatory unit of Centro Hospitalar Universitário do Porto between March 2016 and March 2020 was performed. Children with orofacial congenital anomalies were excluded and 1256 children met the eligibility criteria. The associations between maternal and neonatal factors and the development of atopy, recurrent infections and obstructive sleep apnea were analyzed. ResultsAtopic children showed higher birth weight percentile (p < 0,001) and birth weight-for-length index (p < 0,001) compared with non-atopic. Weight-at-surgery was also higher in atopic patients (p = 0,002). Maternal atopy significantly increased the risk of children atopic disease (p < 0,001; Odds Ratio 4,359). Children indicated for surgery for recurrent infections showed lower birth weight-for-length index (p = 0,038) and lower probability of atopic disease (p < 0,001). Recurrent acute otitis media related to both lower birth weight-for-length index (p = 0,002) and birth body mass index (p = 0,023). There was not a significant higher incidence of sleep apnea in preterm infants (p = 0,488). Obstructive sleep apnea patients showed lower weight-at-surgery percentile (p = 0,045). ConclusionThis work suggests an association between birth anthropometric measurements and atopic and infectious diseases later in life, irrespective of gestational age. There was no consistent association between perinatal parameters and obstructive sleep apnea, but the impact of disordered breathing in childhood anthropometry was significative.

High variability in nurses' tactile stimulation methods in response to apnoea of prematurity-A neonatal manikin study.

AimNeonatal intensive care unit (NICU) nurses provide tactile stimulation to terminate apnoea in preterm infants, but guidelines recommending specific methods are lacking. In this study, we evaluated current methods of tactile stimulation performed by NICU nurses.MethodsNurses were asked to demonstrate and explain their methods of tactile stimulation on a manikin, using an apnoea scenario. All nurses demonstrated their methods three times in succession, with the manikin positioned either prone, supine or lateral. Finally, the nurses were asked how they decided on the methods of tactile stimulation used. The stimulation methods were logged in chronological order by describing both the technique and the location. The nurses' explanations were transcribed and categorised.ResultsIn total, 47 nurses demonstrated their methods of stimulation on the manikin. Overall, 57 different combinations of technique and location were identified. While most nurses (40/47, 85%) indicated they learned how to stimulate during their training, 15/40 (38%) of them had adjusted their methods over time. The remaining 7/47 (15%) stated that their stimulation methods were self‐developed.ConclusionTactile stimulation performed by NICU nurses to terminate apnoea was highly variable in both technique and location, and these methods were based on either prior training or intuition.

Caffeine citrate maintenance doses effect on extubation and apnea postventilation in preterm infants.

Caffeine citrate is used to prevent apnea in premature infants and help in extubation of invasive ventilation, but the optimal dose remains undetermined. Neonates born at less than 30 weeks gestation who had received invasive ventilation for at least 48 hours and a loading dose of 20 mg/kg caffeine citrate were randomly assigned into high (10 mg/kg daily) or low (5 mg/kg daily) maintenance dose groups. The drug was discontinued if no apnea occurred for 7 consecutive days. A total of 111 infants were assigned into the high (54) or low (57) dose groups. Extubation failure (16.7% vs 36.8%), age of extubation (8.2 ± 2.1 vs 10.7 ± 2.3 day), duration of invasive ventilation (7.2 ± 2.1 vs 8.5 ± 2.4 day), duration of ventilation before extubation (8.0 ± 1.8 vs 10.1 ± 1.9 day), and number of days of apnea (1.8 ± 1.3 vs 3.2 ± 1.1 day) were significantly lower in the high dose group than the low dose group. Difference in time until failure (6.7 ± 1.7d vs 7.0 ± 1.9d) and duration of nasal continuous positive airway pressure(7.8 ± 1.8 vs 8.0 ± 2.2 day) were not significant. Furthermore, no significant differences in the incidence of tachycardia (9.3% vs 12.3%), abdominal distension (16.7% vs 12.3%), feeding intolerance (3.7% vs 5.3%), or irritability (7.4% vs 5.3%) were observed between groups. A higher maintenance dose of caffeine citrate reduced the incidence of extubation failure and apnea of prematurity without increasing the occurrence of adverse reactions.