Diaphragmatic pacing in infants: techniques and results.

Phrenic nerve pacing was employed in 8 infants with central hypoventilation syndrome. Their ages ranged from 2.5 to 8.5 months. Preoperative diagnosis was established by demonstrating inadequate ventilatory response to hypercapnia and hypoxia. Percutaneous measurements of phrenic nerve conduction time and diaphragmatic action potentials were performed prior to operation to assess the feasibility of diaphragmatic pacing. A single anterolateral thoracotomy incision was used for both electrode placement in the chest and receiver implantation in the flank. The stimulating electrode was inserted around a segment of intrathoracic phrenic nerve isolated with pleura and perineural blood supply. Follow-up is available on all patients six months to 8 years postoperatively. There were no complications or deaths related to the procedure. In all patients, bilateral phrenic nerve stimulation allowed either marked decrease in or discontinuation of positive-pressure ventilation. Phrenic nerve pacing can be performed safely in infants. It provides an effective alternative method for ventilatory support without the drawbacks of positive-pressure ventilation.