The effect of carbon dioxide inhalation on phase characteristics of breathing movements in healthy newborn infants.

Chest wall distortion (inward motion of the rib cage on inspiration) has been found recently to reduce the tidal volume during active sleep in the neonatal period. To determine some of the factors that relate to the chest wall distortion and the decreased tidal volume seen in active sleep, a quantification of the phase differences between the movements of the chest wall and those of the abdominal wall, and of the relation of their phase differences to tidal volume was performed on data obtained before and during carbon dioxide stimulation in 15 newborn infants sleeping in the prone position. In quiet sleep, the breathing movements were congruent and regular, and the tidal volume and the mean inspiratory flow increased during carbon dioxide stimulation. In active sleep during exposure to carbon dioxide, the chest wall distortion decreased, the breathing movements were incongruent and the degree of the chest wall distortion was negatively correlated with the tidal volume, while the tidal volume and the mean inspiratory flow was increased. Chest wall distortion did not appear in quiet sleep and was decreased in active sleep in spite of increased ventilation during CO2 stimulation. This study favours the idea that chest wall distortion is caused by a well regulated change in neuromuscular activity and not by the strength of diaphragmatic movements overcoming the mechanical stability of the rib cage.