Changes in the temporal structure of periodic breathing with postnatal development in preterm infants.

Abstract

The progressive decrease in the periodic cycle duration (PCD) of periodic breathing with postnatal age in term infants has been previously reported by a number of authors and is thought to be associated with peripheral chemoreceptor maturation. We hypothesized that a similar decrease should be observed in preterm infants. Therefore, in this study we measured the changes in PCD with postnatal age in a small group of preterm (n = 4) infants followed longitudinally (36 afternoon nap studies) over the first 6 mo postnatally. PCD declined in these infants from 17.1 +/- 3.3 s (mean +/- 2 SD) at 9 d to 9.8 +/- 3.2 s (mean +/- 2 SD) at 105 d. The regression slope was - 0.072 s/d. Beyond 105 d there was no change in PCD up to 6 mo postnatally. We found no significant difference between active and quiet sleep. These results are similar to results previously published in term infants but apparently contradict recent data on a group of preterm infants. Possible reasons for this discrepancy are discussed. By examining long epochs of periodic breathing in these infants we also identified characteristic changes in PCD and V/A ratio, defined as the duration of the ventilatory period divided by the duration of the apneic interval, V/A ratio fell from the start of an epoch from 1.21 +/- 0.08 (mean +/- SEM) to a minimum of 0.62 +/- 0.03 and then increased again to 0.8 +/- 0.05 at the end of the epoch. We conclude that important maturational changes occur in the neonatal respiratory control system during the first 6 mo postnatally and that these changes are reflected in a fall in PCD of periodic breathing over this period. We also conclude that the characteristic changes which occur in V/A ratio and PCD are consistent with a role for chemical stimuli in the genesis of periodic breathing.