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Apnea Monitoring Studies
Cardiorespiratory Events in Preterm Infants Referred for Apnea Monitoring Studies. DiFiore JM, Arko MK, Miller MJ, et al. Pediatrics 2001 (Dec); 108:1304-8.
Twelve hour bedside apnea monitoring studies were performed on 68 preterm infants, 35 who were referred for evaluation of persistent bedside monitor alarms (referral group) and 33 who had no documented cardiorespiratory events for at least 2 days prior to the study (control group).
Results. The incidence of apnea > 20 seconds was low and not significantly different between groups (0.7+/- 0.4 events for infants in the referral group vs. 0.3 +/-0.2 events in the control group). On average, the referral infants had a > 3x higher incidence of bradycardia and desaturation episodes than the controls. These episodes of bradycardia and desaturation were always preceded by a respiratory pause that was shorter in the referral infants (10+/- 0.4 sec vs. 12+/- 1 sec). Baseline oxygen saturation was also lower in referrals than controls (95% vs. 98%), and the incidence of periodic breathing was significantly higher.
Comment. This study gives us some important insight into the pathophysiology of persistent apnea of prematurity. Pathologic apnea (>20 seconds) was very rare, while bradycardia and desaturation events preceded by brief apneas were common. Infants with persistent bedside alarms also have lower baseline oxygen saturations, possibly indicating residual chronic lung disease. It follows that premature infants with mild chronic lung disease may have abnormal respiratory control in response to mild hypoxemia. Treatment directed at improving their pulmonary function might be the best way to resolve their bradycardia and desaturation events.
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