Ventilatory control instability as a predictor of persistent periodic breathing in preterm infants

Leon S. Siriwardhana, Alicia K. Yee, Dwayne L. Mann, Shrinkhala Dawadi, Gillian M. Nixon, Flora Y. Wong, Bradley A. Edwards, Rosemary S.C. Horne

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Periodic breathing (PB) is common in preterm infants. We aimed to characterize the contribution of ventilatory control instability to the presence and persistence of PB longitudinally. Methods: Infants born between 28 and 32 weeks of gestation were studied using daytime polysomnography at: 32–36 weeks postmenstrual age (PMA) (N = 32), 36–40 weeks PMA (N = 20), 3 months corrected age (CA) (N = 18) and 6 months CA (N = 19). Loop gain, a measure of sensitivity of the ventilatory control system, was estimated by fitting a mathematical model to ventilatory patterns associated with spontaneous sighs. Results: The time spent in PB decreased from 32–36 weeks PMA to 6 months CA (P = 0.005). Across all studies, studies with PB (N = 62) were associated with higher loop gain compared to those without PB (N = 23) (estimated marginal mean ± SEM: 0.445 ± 0.01 vs 0.388 ± 0.02; P = 0.020). A threshold of loop gain >0.415 (measured at 32–36 weeks PMA) provided a sensitivity of 86% and a specificity of 75% to detect the presence of PB at 6 months CA. Conclusions: The course of PB in preterm infants is related to changes in loop gain. Higher loop gain at 32–36 weeks PMA was associated with a greater risk of persistent PB at 6 months CA. Impact: The developmental trajectory of periodic breathing and its relationship to ventilatory control instability is currently unclear.Unstable ventilatory control is a determinant of periodic breathing in preterm infants up to 6 months corrected age.Infants who display greater ventilatory control instability at 32–36 weeks postmenstrual age may be at increased risk of persistent periodic breathing at 6 months corrected age.Assessment of ventilatory control stability may assist in the early identification of infants at risk of persistent periodic breathing and its potential adverse effects.

Original languageEnglish
Number of pages7
JournalPediatric Research
DOIs
Publication statusAccepted/In press - Oct 2021

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