Abstract
Background: In extremely preterm infants, persistence of cardioventilatory events is associated with long-term morbidity. Therefore, the objective was to characterize physiologic growth curves of apnea, periodic breathing, intermittent hypoxemia, and bradycardia in extremely preterm infants during the first few months of life. Methods: The Prematurity-Related Ventilatory Control study included 717 preterm infants <29 weeks gestation. Waveforms were downloaded from bedside monitors with a novel sharing analytics strategy utilized to run software locally, with summary data sent to the Data Coordinating Center for compilation. Results: Apnea, periodic breathing, and intermittent hypoxemia events rose from day 3 of life then fell to near-resolution by 8–12 weeks of age. Apnea/intermittent hypoxemia were inversely correlated with gestational age, peaking at 3–4 weeks of age. Periodic breathing was positively correlated with gestational age peaking at 31–33 weeks postmenstrual age. Females had more periodic breathing but less intermittent hypoxemia/bradycardia. White infants had more apnea/periodic breathing/intermittent hypoxemia. Infants never receiving mechanical ventilation followed similar postnatal trajectories but with less apnea and intermittent hypoxemia, and more periodic breathing. Conclusions: Cardioventilatory events peak during the first month of life but the actual postnatal trajectory is dependent on the type of event, race, sex and use of mechanical ventilation. Impact: Physiologic curves of cardiorespiratory events in extremely preterm-born infants offer (1) objective measures to assess individual patient courses and (2) guides for research into control of ventilation, biomarkers and outcomes. Presented are updated maturational trajectories of apnea, periodic breathing, intermittent hypoxemia, and bradycardia in 717 infants born <29 weeks gestation from the multi-site NHLBI-funded Pre-Vent study. Cardioventilatory events peak during the first month of life but the actual postnatal trajectory is dependent on the type of event, race, sex and use of mechanical ventilation. Different time courses for apnea and periodic breathing suggest different maturational mechanisms.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1060-1069 |
| Number of pages | 10 |
| Journal | Pediatric research |
| Volume | 95 |
| Issue number | 4 |
| DOIs | |
| State | Published - Mar 2024 |
Funding
The National Institutes of Health (NIH) and the National Heart, Lung, and Blood Institute (NHLBI) provided grant support through cooperative agreements. While NHLBI staff had input into study design, conduct, analysis, and manuscript drafting, the content and views expressed in this article are solely the responsibility of the authors and do not necessarily represent the official views of NIH or the U.S. Department of Health and Human Services. Participating sites collected and stored the data while the University of Virginia (UVa), the lead data and coordinating center (LDCC), analyzed the data. The co-PIs at each site had full access to her/his individual site data and take responsibility for the integrity of the raw waveforms while Dr. Randall Moorman (LDCC co-PI) and Dr. Douglas Lake (LDCC co-PI) take responsibility for the integrity of the data and accuracy of the data analysis. We are indebted to our medical and nursing colleagues and the infants and their parents who agreed to take part in this study. The following individuals, in addition to those listed as authors, participated in this study: NIH/NHLBI: Neil Aggarwal: NHLBI, Division of Lung Diseases, Bethesda, MD; Lawrence Baizer: NHLBI, Division of Lung Diseases, Bethesda, MD; Peyvand Ghofrani: NHLBI, Division of Lung Diseases, Bethesda, MD; Aaron Laposky: NHLBI, Division of Lung Diseases, Bethesda, MD; Aruna Natarajan: NHLBI, Division of Lung Diseases, Bethesda, MD; Barry Schmetter: NHLBI, Division of Lung Diseases, Bethesda, MD; OSMB: Estelle Gauda (Chair): University of Toronto Hospital for Sick Children, Division of Neonatology, Toronto, Ontario; Jonathan Davis: Tufts Clinical and Translational Science Institute, Division of Newborn Medicine, Boston, MA; Roberta Keller: University of California, San Francisco School of Medicine, Department of Pediatrics, San Francisco CA; Robinder Khemani: Children\u2019s Hospital Los Angeles, Department of Anesthesiology and Critical Care Medicine, Los Angeles, CA; Renee Moore: Drexel University Department of Epidemiology and Biostatistics, Philadelphia, PA; Elliott Weiss: Department of Pediatrics, University of Washington School of Medicine, Seattle, WA; University of Virginia: Amy Camblos: UVa School of Medicine, Clinical Trials Office, UVa School of Medicine, Charlottesville, VA; Gina Duda: UVa School of Medicine, Clinical Trials Office, UVa School of Medicine, Charlottesville, VA; Abigail Flower: UVa, Data Science Institute, Charlottesville, VA; Steven Fowler: UVa School of Medicine, Clinical Trials Office, UVa School of Medicine, Charlottesville, VA; Patcharin Pramoonjago: UVa School of Medicine, Biorepository and Tissue Research Facility, Charlottesville, VA; Craig Rumpel: UVa School of Medicine, Biorepository and Tissue Research Facility, Charlottesville, VA; Northwestern University: Michael Carroll: Ann & Robert H. Lurie Children\u2019s Hospital of Chicago and Stanley Manne Children\u2019s Research Institute, Data Analytics and Reporting, Chicago, IL; Bradley Hopkins: Ann & Robert H. Lurie Children\u2019s Hospital of Chicago, Pediatric Autonomic Medicine, Chicago, IL; University of Alabama at Birmingham: David Paydarfar: University of Texas Austin, Department of Neurology at Dell Medical School, Austin, TX; Elisabeth Salisbury: University of Massachusetts Medical School, Department of Pediatrics and Neurology, Worcester, MA; Bradley Troxler: University of Alabama at Birmingham School of Medicine, Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Birmingham, AL; Washington University: Ryan Colvin: Washington University School of Medicine in St. Louis, Division of General Medicine, St. Louis, MO; Joey Egan: St. Louis Children\u2019s Hospital, Respiratory Care, St. Louis, MO; Elise Eiden: Washington University School of Medicine in St. Louis, Institute for Informatics, St. Louis, MO; Jeffery Hoover: Washington University School of Medicine in St. Louis, Division of Newborn Medicine, St. Louis, MO; Laura Linneman: Washington University School of Medicine in St. Louis, St. Louis, MO; Daniel Mammel: Washington University School of Medicine in St. Louis, Division of Newborn Medicine, St. Louis, MO; Michael McLeland: St. Louis Children\u2019s Hospital, Sleep Laboratory, St. Louis, MO; Harley Pyles: St. Louis Children\u2019s Hospital, Respiratory Care, St. Louis, MO; Barbara Warner: Washington University School of Medicine in St. Louis, Division of Newborn Medicine, St. Louis, MO. This work was supported by NIH grants as follows: University of Virginia (NCT03174301): U01 HL133708, HL133708-05S1; Case Western Reserve University: U01 HL133643, The Gerber Foundation; Northwestern University: U01 HL133704; University of Alabama at Birmingham: U01 HL133536; University of Miami: U01 HL133689; Washington University: U01 HL133700.
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health