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Neonatology pp 415-422 | Cite as

Control of Breathing in Newborns

  • Ruben Alvaro
  • Henrique Rigatto

Abstract

There are at least three important considerations regarding the study of the control of breathing during the neonatal period. First, the neonates are noncooperative subjects. This means that we must study their respiratory control without their being aware and try to compare the measurements with those of the adult under similar conditions. This is difficult to do. Second, measurements in the neonate are usually made, by necessity, in the decubitus position, whereas those in the adult subject are usually made in the sitting or standing position [1, 2]. Third, babies are usually studied with a nosepiece because they are nose breathers; adults are usually studied using a mouthpiece. These methodological differences have made comparison of breathing in newborns with that in adult subjects difficult to interpret. There is currently a major need for studies to be done using similar methodology. Unless there is some consistency in the methodology, it is hard to define what is actually distinct or unique about the control of breathing in the neonate. In recent years, we have experienced tremendous advances in the field of respiratory control, and we are now witnessing the initial discovery of several of the genes that control the development and maturation of multiple neurally controlled respiratory functions

Keywords

Sleep State Periodic Breathing Central Apnea Obstructive Apnea Peripheral Chemoreceptor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Davi M, Sankaran K, Maccallum M et al (1979) Effect of sleep state on chest distortion and on the ventilatory response to CO2 in neonates. Pediatr Res 13: 982–986PubMedCrossRefGoogle Scholar
  2. 2.
    Kalapesi Z, Durand M, Leahy FN et al (1981) Effect of periodic or regular respiratory pattern on the ventilatory response to low inhaled CO2 in preterm infants during sleep. Am Rev Respir Dis 123: 8–11PubMedGoogle Scholar
  3. 3.
    Cross KW, Oppé TE (1952) The effect of inhalation of high and low concentrations of oxygen on the respiration of the premature infant. J Physiol 117: 38–55PubMedGoogle Scholar
  4. 4.
    Waggener TB et al (1984) Apnea duration is related to ventilator oscillation characteristics in newborn infants. J Appl Physiol 57: 536–544PubMedGoogle Scholar
  5. 5.
    Douglas CG, Haldane JS (1908-1909) The causes of periodic or Cheyne-Stokes breathing. J Physiol 38: 401–419Google Scholar
  6. 6.
    Rigatto H, Kalapesi Z, Leahy FN et al (1982) Ventilatory response to 100% and 15% O2 during wakefulness and sleep in preterm infants. Early Hum Dev 7: 1–10PubMedCrossRefGoogle Scholar
  7. 7.
    Gabriel M, Albani M, Schulte FJ (1976) Apneic spells and sleep states in preterm infants. Pediatrics 57: 142–147PubMedGoogle Scholar
  8. 8.
    Curzi-Dascalova L, Challamel MJ (2000) Neurophysiological basis of sleep development. In: Loughlin GM, Carroll JL, Marcus CL (eds) Sleep and breathing in children. A developmental approach. Marcel Dekker, New York, pp 3–37Google Scholar
  9. 9.
    Lehtonen L, Martin RJ (2004) Ontogeny of sleep and awake states in relation to breathing in preterm infants. Semin Neonatol 3: 229–238CrossRefGoogle Scholar
  10. 10.
    Moriette G, Van Reempts P, Moore M et al (1985) The effect of rebreathing CO2 on ventilation and diaphragmatic electromyography in newborn infants. Respir Physiol 62: 387–397PubMedCrossRefGoogle Scholar
  11. 11.
    Prechtl HRF (1974) The behavioural states of the newborn infant (a review). Brain Res 76: 185–212PubMedCrossRefGoogle Scholar
  12. 12.
    Rigatto H (1988) Control of breathing in the neonate and the sudden infant death syndrome. In: Fishman AP (ed) Pulmonary diseases and disorders, 2nd edn. McGraw-Hill, New York, pp 1363–1372Google Scholar
  13. 13.
    Rigatto H (1986) Disorders of the control of breathing. In: National Heart, Lung, and Blood Institute. Pediatric Respiratory Diseases. National Institutes of Health, Publication no. 86-2107, Bethesda, pp 20–25Google Scholar
  14. 14.
    Lee D, Caces R, Kwiatkowski K et al (1987) A developmental study on types and frequency distribution of short apneas (3 to 15 seconds) in term and preterm infants. Pediatr Res 22: 344–349PubMedCrossRefGoogle Scholar
  15. 15.
    Lemke RP, Al-Saedi SA, Alvaro RE et al (1996) Use of a magnified cardiac airflow oscillation to classify neonatal apnea. Am J Respir Crit Care Med 154: 1537–1542PubMedGoogle Scholar
  16. 16.
    Al-Sufayan F, Bamehrez M, Kwiatkowski K, Alvaro RE (2009) The effects of airway closure in central apneas and obstructed respiratory efforts in mixed apneas in preterm infants. Pediatr Pulmonol 44: 253–259PubMedCrossRefGoogle Scholar
  17. 17.
    Mathew OP, Roberts JL, Thach BT (1982) Pharyngeal airway obstruction in preterm infants during mixed and obstructive apnea. J Pediatr 100: 964–968PubMedCrossRefGoogle Scholar
  18. 18.
    Purpura DP (1975) Dendritic differentiation in human cerebral cortex: normal and aberrant development patterns. In: Kreutzberg GW (ed) Advances in neurology, vol 9. Raven Press, New York, pp 91–116Google Scholar
  19. 19.
    Martin RJ, Wilson CG, Abu-Shaweesh JM, Haxhiu MA (2004) Role of inhibitory neurotransmitter interactions in the pathogenesis of neonatal apnea: implications for management. Semin Perinatol 28: 273–278PubMedCrossRefGoogle Scholar
  20. 20.
    Al-Saedi SA, Lemke RP, Haider AZ et al (1997) Prolonged apnea in the preterm infant is not a random event. Am J Perinatol 14: 195–200PubMedCrossRefGoogle Scholar
  21. 21.
    Rigatto H, Brady JP (1972) Periodic breathing and apnea in preterm infants. I: evidence for hypoventilation possibly due to central respiratory depression. Pediatrics 50: 202–218PubMedGoogle Scholar
  22. 22.
    Al-Matary A, Kutbi I, Qurashi M et al (2004) Increased peripheral chemoreceptor activity may be critical in destabilizing breathing in neonates. Semin Perinatol 24: 264–272CrossRefGoogle Scholar
  23. 23.
    Khan A, Qurashi M, Kwiatkowski K et al (2005) Measurement of the CO2 apneic threshold in newborn infants: possible relevance for periodic breathing and apnea. J Appl Physiol 98: 1171–1176PubMedCrossRefGoogle Scholar
  24. 24.
    Xie A, Skatrud JB, Puleo DS et al (2006) Influence of arterial O2 on the susceptibility to posthyperventilation apnea during sleep. J Appl Physiol 100: 171–177PubMedCrossRefGoogle Scholar
  25. 25.
    Xie A, Skatrud JB, Dempsey JA (2001) Effect of hypoxia on the hypopnoeic and apnoeic threshold for CO2 in sleeping humans. J of Physiol 535: 269–278CrossRefGoogle Scholar
  26. 26.
    Rigatto H, Reis F, Cates D, Horvath L (1982) Effect of sleep on phasic and “tonic” diaphragmatic EMG in preterm infants. Fed Proc 41: 1103Google Scholar
  27. 27.
    Thibeault DW, Wong MM, Auld PA (1967) Thoracic gas volume changes in premature infants. Pediatrics 40: 403–411PubMedGoogle Scholar
  28. 28.
    Reed DJ, Kellogg RH (1958) Changes in respiratory response to CO2 during natural sleep at sea level and at altitude. J Appl Physiol 13: 325–330PubMedGoogle Scholar
  29. 29.
    Phillipson EA (1978) Control of breathing during sleep. Am Rev Respir Dis 118: 909–939PubMedGoogle Scholar
  30. 30.
    Phillipson EA, Kozar LF, Rebuck AS, Murphy E (1977) Ventilatory and waking responses to CO2 in sleeping dogs. Am Rev Respir Dis 115: 251–259PubMedGoogle Scholar
  31. 31.
    Rigatto H, Brady JP (1972) Periodic breathing and apnea in preterm infants. II: hypoxia as a primary event. Pediatrics 50: 219–228PubMedGoogle Scholar
  32. 32.
    Brady JP, Ceruti E (1966) Chemoreceptor reflexes in the new-born infant: Effects of varying degrees of hypoxia on heart rate and ventilation in a warm environment. J Physiol London 184: 631–645PubMedGoogle Scholar
  33. 33.
    Brady JP, Cotton EC, Tooley WH (1964) Chemoreflexes in the newborn infant: Effects of 100% oxygen on heart rate and ventilation. J Physiol London 17: 332–341Google Scholar
  34. 34.
    Easton PA, Slykerman LJ, Anthonisen NR (1988) Recovery of the ventilatory response to hypoxia in normal adults. J Appl Physiol 64: 521–528PubMedCrossRefGoogle Scholar
  35. 35.
    Mortola JP (1999) How newborn mammals cope with hypoxia. Respir Physiol 116: 95–103PubMedCrossRefGoogle Scholar
  36. 36.
    Elnazir B, Marshall JM, Kumar P (1996) Postnatal development of the pattern of respiratory and cardiovascular response to systemic hypoxia in the piglet: the roles of adenosine. J Physiol 492 (Part 2): 573–585PubMedGoogle Scholar
  37. 37.
    Kneussl MP, Pappagianopoulos P, Hoop B, Kazemi H (1986) Effect of centrally administered gamma-aminobutyric acid on metabolic function. J Appl Physiol 61: 472–476PubMedGoogle Scholar
  38. 38.
    Di Pasquale E, Morin D, Monteau R, Hilaire G (1992) Serotonergic modulation of the respiratory rhythm generator at birth: an in vitro study in the rat. Neurosci Lett 143: 91–95PubMedCrossRefGoogle Scholar
  39. 39.
    Xia Y, Haddad GG (1991) Ontogeny and distribution of opioid receptors in the rat brainstem. Brain Res 549: 181–193PubMedCrossRefGoogle Scholar
  40. 40.
    Gozal D, Simakajornboon N, Czapla MA et al (2000) Brainstem activation of platelet-derived growth factor-beta receptor modulatesthe late phase of the hypoxic ventilatory response J Neurochem 74: 310–319Google Scholar
  41. 41.
    LaFramboise WA, Guthrie RD, Standaert TA, Woodrum DE (1983) Pulmonary mechanics during the ventilatory response to hypoxemia in the newborn monkey. J Appl Physiol 55: 1008–1014PubMedGoogle Scholar
  42. 42.
    LaFramboise WA, Woodrum DE (1985) Elevated diaphragm electromyogram during neonatal hypoxic ventilatory depression. J Appl Physiol 59: 1040–1045PubMedGoogle Scholar
  43. 43.
    Harned HS Jr, Ferreiro J (1973) Initiation of breathing by cold stimulation: effects of change in ambient temperature on respiratory activity of the full-term fetal lamb. J Pediatr 83:663–669 58 Control of Breathing in Newborns 421Google Scholar
  44. 44.
    Aizad T, Bodani J, Cates D (1984) Effect of a single breath of 100% oxygen on respiration in neonates during sleep. J Appl Physiol 57: 1531–1535PubMedGoogle Scholar
  45. 45.
    Davi M, Sankaran K, Rigatto H (1980) Effect of inhaling 100% O2 on ventilation and acid-base balance in cerebrospinal fluid in neonates. Biol Neonate 38: 85–89PubMedCrossRefGoogle Scholar
  46. 46.
    Lucier GE, Storey AT, Sessle BJ (1979) Effects of upper respiratory tract stimuli on neonatal respiration: reflex and single neuron analyses in the kitten. Biol Neonate 35: 82–89PubMedCrossRefGoogle Scholar
  47. 47.
    Thach BT (2001) Maturation and transformation of reflexes that protect the laryngeal airway from liquid aspiration from fetal to adult life. Am J Med 111: 69S–77SPubMedCrossRefGoogle Scholar
  48. 48.
    Martin RJ, Abu-Shaweesh JM (2005) Control of breathing and neonatal apnea. Biol Neonate 87: 288–295PubMedCrossRefGoogle Scholar
  49. 49.
    Lindgren C, Jing L, Graham B et al (1992) Respiratory syncytial virus infection reinforces reflex apnea in young lambs. Pediatr Res 31 (4 Pt 1): 381–385PubMedCrossRefGoogle Scholar
  50. 50.
    Miller MJ, DiFiore JM (1995) A comparison of swallowing during apnea and periodic breathing in premature infants Pediatr Res 37: 796–799Google Scholar
  51. 51.
    Pickens DL, Schefft G, Thach BT (1988) Prolonged apnea associated with upper airway protective reflexes in apnea of prematurity. Am Rev Respir Dis 137: 113–118PubMedCrossRefGoogle Scholar
  52. 52.
    Gewolb IH, Vice FL, Schwietzer-Kenney EL et al (2001) Developmental patterns of rhythmic suck and swallow in preterm infants. Dev Med Child Neurol 43: 22–27PubMedCrossRefGoogle Scholar
  53. 53.
    Kurth CD, Hutchison AA, Caton DC, Davenport PW (1989) Maturational and anesthetic effects on apneic thresholds in lambs. J Appl Physiol 67: 643–647PubMedGoogle Scholar
  54. 54.
    Cross KW, Klaus M, Tooley WH, Weisser K (1960) The response of the new-born baby to inflation of the lungs. J Physiol 151: 551–565PubMedGoogle Scholar
  55. 55.
    Olinsky A, Bryan MH, Bryan AC (1974) Influence of lung inflation on respiratory control in neonates. J Appl Physiol 36: 426–429PubMedGoogle Scholar
  56. 56.
    Fleming PJ, Bryan AC, Bryan MH (1978) Functional immaturity of pulmonary irritant receptors and apnea in newborn preterm infants. Pediatrics 61: 515–518PubMedGoogle Scholar
  57. 57.
    Bodani J, Tazeem A, Yorke K, Rigatto H (1984) The effect of periodic breathing and sleep state on the incidence and “structure” of augmented breaths in neonates. Pediatr Res 18: 402AGoogle Scholar
  58. 58.
    Thach BT, Tauesch HW (1976) Sighing in human newborn infants: role of inflation-augmenting reflex. J Appl Physiol 41: 502–507PubMedGoogle Scholar
  59. 59.
    Alvarez JE, Bodani J, Fajardo CA (1993) Sighs and their relationship to apnea in the newborn infant. Biol Neonate 63: 139–146PubMedCrossRefGoogle Scholar
  60. 60.
    Bradley TD (2002) Crossing the threshold: implications for central sleep apnea. Am J Respir Crit Care Med 165: 1203–1204PubMedCrossRefGoogle Scholar
  61. 61.
    Henderson-Smart DJ, Read DJC (1979) Reduced lung volume during behavioral active sleep in the newborn. J Appl Physiol 46: 1081–1085PubMedGoogle Scholar
  62. 62.
    Harding R, Johnson P, McClelland ME (1977) Laryngeal function during breathing and swallowing in foetal and newborn lambs. J Physiol London 272: 14P–15 PPubMedGoogle Scholar
  63. 63.
    Dawes GS, Gardner WN, Johnston BM, Walker DW (1982) Effects of hypercapnia on tracheal pressure, diaphragm and intercostal electromyograms in unanesthetized fetal lambs. J Physiol London 326: 461–474PubMedGoogle Scholar
  64. 64.
    Lopes J, Muller NL, Bryan MH, Bryan AC (1981) Importance of inspiratory muscle tone in maintenance of FRC in the newborn. J Appl Physiol 51: 830–834PubMedGoogle Scholar
  65. 65.
    Kosch PC, Hutchinson AA, Wozniak JA et al (1988) Posterior cricoarytenoid and diaphragm activities during tidal breathing in neonates. J Appl Physiol 64: 1968–1978PubMedGoogle Scholar
  66. 66.
    Remmers JE, Bartlett D Jr (1977) Reflex control of expiratory airflow and duration. J Appl Physiol 42: 80–87PubMedGoogle Scholar
  67. 67.
    Remmers JE, deGroot WJ, Sauerland EK, Anch AM (1978) Pathogenesis of upper airway occlusion during sleep. J Appl Physiol 44: 931–938PubMedGoogle Scholar
  68. 68.
    Reis FJC, Cates DB, Vandriault LV et al (1994) Diaphragmatic activity and ventilation in preterm infants - The effects of sleep state. Biol Neonate 65: 16–24PubMedCrossRefGoogle Scholar
  69. 69.
    Harding R, Johnson P, McClelland ME (1980) Respiratory function of the larynx in developing sheep and the influence of sleep state. Respir Physiol 40: 165–167PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • Ruben Alvaro
    • 1
  • Henrique Rigatto
  1. 1.Department of PediatricsUniversity of ManitobaWinnipegCanada

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