The characteristics of the arterial oxygen saturation (Sao 2) signal during episodes of hypoxaemia (Sao 2 ≤ 80% for ≥ 4 s) associated with periodic and non-periodic apnoeic pauses were studied in 16 preterm infants with cyanotic episodes (patients), and 15 asymptomatic preterm infants (controls), matched on birthweight and gestational age. The patients showed a significantly higher percentage of apnoeic pauses followed by a hypoxaemic episode (25 vs. 6%, P < 0.01), and a two-fold increase in the slope of the desaturation curve (8.4 vs. 4.3% per s, P < 0.005) in periodic compared with non-periodic breathing. All other characteristics of oxygenation (baseline SaO2 before episodes of hypoxaemia, delay between onset of apnoeic pause and onset of desaturation, lowest Sao2 during episodes of hypoxaemia) were similar for periodic and non-periodic breathing patterns. Similar, but not significant, differences between isolated and periodic apnoeic pauses were also present in the controls. An analysis of episodes of bradycardia (≤ 100 beats per minute (bpm)) showed that out of 121 episodes in the patients 118 were accompanied by a fall in SaO 2 to ≤ 80%, and in the remaining three SaO 2 fell to 82%, 85% and 86%, respectively. Thus all episodes of bradycardia (≤ 100 bpm) were associated with a fall in SaO 2 detected by beat-to-beat pulse oximetry. Examination of hypoxaemic episodes and their relationship with bradycardia and with apnoeic pauses, periodic and non-periodic, may help the further understanding of the control of arterial oxygenation in preterm infants with cyanotic episodes.
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