Fairchild Karen, Mohr Mary, Paget-Brown Alix, Tabacaru Christa, Lake Douglas, Delos John, Moorman Joseph Randall, Kattwinkel John
Department of Pediatrics, The University of Virginia School of Medicine, Charlottesville, Virginia.
Department of Physics, The College of William and Mary, Williamsburg, Virginia.
Pediatr Res. 2016 Jul;80(1):21-7. doi: 10.1038/pr.2016.43. Epub 2016 Mar 9.
Apnea of prematurity (AOP) is nearly universal among very preterm infants, but neither the apnea burden nor its clinical associations have been systematically studied in a large consecutive cohort.
We analyzed continuous bedside monitor chest impedance and electrocardiographic waveforms and oxygen saturation data collected on all neonatal intensive care unit (NICU) patients <35 wk gestation from 2009 to 2014 (n = 1,211; >50 infant-years of data). Apneas, with bradycardia and desaturation (ABDs), defined as central apnea ≥10 s associated with both bradycardia <100 bpm and oxygen desaturation <80%, were identified using a validated automated algorithm.
Number and duration of apnea events decreased with increasing gestational age (GA) and postmenstrual age (PMA). ABDs were more frequent in infants <31 wk GA at birth but were not more frequent in those with severe retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), or severe intraventricular hemorrhage (IVH) after accounting for GA. In the day before diagnosis of late-onset septicemia and necrotizing enterocolitis, ABD events were increased in some infants. Many infants continued to experience short ABD events in the week prior to discharge home.
Frequency of apnea events is a function of GA and PMA in infants born preterm, and increased apnea is associated with acute but not with chronic pathologic conditions.
早产呼吸暂停（AOP）在极早产儿中几乎普遍存在，但在一个大型连续队列中，尚未对呼吸暂停负担及其临床关联进行系统研究。
我们分析了2009年至2014年期间所有孕周<35周的新生儿重症监护病房（NICU）患者（n = 1211；超过50个婴儿年的数据）的连续床边监测的胸部阻抗、心电图波形和血氧饱和度数据。使用经过验证的自动算法识别伴有心动过缓和血氧饱和度下降（ABD）的呼吸暂停，定义为中枢性呼吸暂停≥10秒，同时伴有心率<100次/分和血氧饱和度<80%。
呼吸暂停事件的数量和持续时间随着胎龄（GA）和孕龄（PMA）的增加而减少。出生时GA<31周的婴儿中ABD更常见，但在考虑GA后，患有严重早产儿视网膜病变（ROP）、支气管肺发育不良（BPD）或严重脑室内出血（IVH）的婴儿中ABD并不更常见。在诊断迟发性败血症和坏死性小肠结肠炎的前一天，一些婴儿的ABD事件增加。许多婴儿在出院前一周仍继续经历短暂的ABD事件。
早产婴儿呼吸暂停事件的频率是GA和PMA的函数，呼吸暂停增加与急性而非慢性病理状况相关。
