Control of laryngeal muscle activity in preterm infants.

Control of upper airway muscles, such as those in the larynx, appears important for optimizing airflow patterns during normal respiration. Electromyograms (EMGs) of the laryngeal (LAR) area and diaphragm (DIA) were recorded with esophageal and skin electrodes, respectively, in 12 unsedated sleeping preterm infants during changes in chemical and mechanical feedback. Onset of phasic inspiratory LAR EMG preceded both DIA EMG and inspiratory airflow by 70 +/- 60 and 180 +/- 80 ms, respectively. Inhalation of 4% CO2 increased both peak LAR and DIA EMGs but did not alter their temporal relationships. End expiratory occlusion prolonged both LAR (600 +/- 120 to 930 +/- 290 ms, p less than 0.05) and DIA EMGs (690 +/- 180 to 940 +/- 270 ms, p less than 0.005) as well as mechanical inspiratory time. Early braking of expiratory flow was accompanied by persistence of DIA EMG into the expiratory phase, while termination of mid- to late expiratory braking was associated with onset of the LAR EMG of the subsequent inspiration. We conclude that respiratory activity of the LAR EMG is altered by both chemical and mechanoreceptor stimulation. Furthermore, simultaneous recording of LAR and DIA EMGs suggests that upper airway and chest wall muscles have different effects on expiratory flow patterns in human infants.