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Physiologic Basis for Intermittent Hypoxic Episodes in Preterm Infants

  • R. J. MartinEmail author
  • J. M. Di Fiore
  • P. M. MacFarlane
  • C. G. Wilson
Conference paper
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 758)

Abstract

Intermittent hypoxic episodes are typically a consequence of immature respiratory control and remain a troublesome challenge for the neonatologist. Furthermore, their frequency and magnitude are commonly underestimated by clinically employed pulse oximeter settings. In extremely low birth weight infants the incidence of intermittent hypoxia [IH] progressively increases over the first 4 weeks of postnatal life, with a subsequent plateau followed by a slow decline beginning at weeks six to eight. Over this period of unstable respiratory control, increased oxygen-sensitive peripheral chemoreceptor activity has been associated with a higher incidence of apnea of prematurity. In contrast, infants with bronchopulmonary dysplasia [chronic neonatal lung disease] exhibit decreased peripheral chemosensitivity, although the effect on respiratory stability in this population is unclear. Such episodic hypoxia/reoxygenation in early life has the potential to sustain a proinflammatory cascade with resultant multisystem, including respiratory, morbidity. Therapeutic approaches for intermittent hypoxic episodes comprise careful titration of baseline or supplemental inspired oxygen as well as xanthine therapy to prevent apnea of prematurity. Characterization of the pathophysiologic basis for such intermittent hypoxic episodes and their consequences during early life is necessary to provide an evidence-based approach to their management.

Keywords

Intermittent hypoxia Apnea Prematurity 

Notes

Acknowledgements

Supported by: NIH Grants R21 HL098628 [RJM] and RO3 HD064830 [CGW] grant

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Copyright information

© Springer Science+Business Media Dordrecht 2012

Authors and Affiliations

  • R. J. Martin
    • 1
    Email author
  • J. M. Di Fiore
    • 1
  • P. M. MacFarlane
    • 1
  • C. G. Wilson
    • 1
  1. 1.Department of Pediatrics Division of Neonatology, Rainbow Babies & Children’s HospitalCase Western Reserve UniversityClevelandUSA

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