Williamson Max, Poorun Ravi, Hartley Caroline
Department of Paediatrics, University of Oxford, Oxford, United Kingdom.
Department of Paediatrics, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom.
Front Pediatr. 2021 Oct 25;9:755677. doi: 10.3389/fped.2021.755677. eCollection 2021.
Infants who are born prematurely are at significant risk of apnoea. In addition to the short-term consequences such as hypoxia, apnoea of prematurity has been associated with long-term morbidity, including poor neurodevelopmental outcomes. Clinical trials have illustrated the importance of methylxanthine drugs, in particular caffeine, in reducing the risk of long term adverse neurodevelopmental outcomes. However, the extent to which apnoea is causative of this secondary neurodevelopmental delay or is just associated in a background of other sequelae of prematurity remains unclear. In this review, we first discuss the pathophysiology of apnoea of prematurity, previous studies investigating the relationship between apnoea and neurodevelopmental delay, and treatment of apnoea with caffeine therapy. We propose a need for better methods of measuring apnoea, along with improved understanding of the neonatal brain's response to consequent hypoxia. Only then can we start to disentangle the effects of apnoea on neurodevelopment in preterm infants. Moreover, by better identifying those infants who are at risk of apnoea, and neurodevelopmental delay, we can work toward a risk stratification system for these infants that is clinically actionable, for example, with doses of caffeine tailored to the individual. Optimising treatment of apnoea for individual infants will improve neonatal care and long-term outcomes for this population.
早产婴儿患呼吸暂停的风险很大。除了缺氧等短期后果外，早产呼吸暂停还与长期发病有关，包括神经发育不良。临床试验已经证明了甲基黄嘌呤药物，特别是咖啡因，在降低长期不良神经发育后果风险方面的重要性。然而，呼吸暂停在多大程度上导致这种继发性神经发育延迟，或者仅仅是与早产的其他后遗症相关，仍不清楚。在这篇综述中，我们首先讨论早产呼吸暂停的病理生理学、以往研究呼吸暂停与神经发育延迟之间关系的情况，以及咖啡因治疗呼吸暂停的情况。我们提出需要更好的呼吸暂停测量方法，同时更好地了解新生儿大脑对随之而来的缺氧的反应。只有这样，我们才能开始理清呼吸暂停对早产儿神经发育的影响。此外，通过更好地识别那些有呼吸暂停和神经发育延迟风险的婴儿，我们可以朝着为这些婴儿建立一个临床可行的风险分层系统努力，例如，根据个体情况调整咖啡因剂量。优化对个体婴儿的呼吸暂停治疗将改善这一人群的新生儿护理和长期预后。
