Clinical Associations with Immature Breathing in Preterm Infants : Part 2: Periodic Breathing

Abstract

Background

Periodic breathing (PB) is a normal immature breathing pattern in neonates that, if extreme, may be associated with pathologic conditions.

Methods

We used our automated PB detection system to analyze all bedside monitor chest impedance data on all infants <35 weeks’ gestation in the University of Virginia Neonatal Intensive Care Unit from 2009-2014 (n=1211). Percent time spent in PB was calculated hourly (>50 infant-years’ data). Extreme PB was identified as a 12h period with PB >6 standard deviations above the mean for gestational age (GA) and post-menstrual age (PMA) and >10% time in PB.

Results

PB increased with GA, with the highest amount in infants 30-33 weeks’ GA at about 2 weeks’ chronologic age. Extreme PB was identified in 76 infants and in 45% was temporally associated with clinical events including infection or necrotizing enterocolitis (NEC), immunizations, or caffeine discontinuation. In 8/28 cases of septicemia and 10/21 cases of NEC there was a >2-fold increase in %PB over baseline in the day prior to diagnosis.

Conclusion

Infants <35 weeks GA spend, on average, <6% of the time in PB. An acute increase in PB may reflect illness or physiological stressors or may occur without any apparent clinical event.