Chen Yiru, Zandvoort Coen S, Baxter Luke, Fatunla Odunayo A T, Ketheeswaranathan Vithushanan, Poorun Ravi, Small Zara, Usman Fatima, Henry Matthew, Berthouze Luc, Villarroel Mauricio, Hartley Caroline
Department of Paediatrics, University of Oxford, Oxford, UK.
University of Exeter Medical School, University of Exeter, Exeter, UK.
Pediatr Res. 2025 Oct 28. doi: 10.1038/s41390-025-04496-x.
Apnoea is a common respiratory complication in preterm neonates, leading to substantial changes in physiology. We conducted this systematic review and meta-analysis to examine the relationship between apnoea duration and changes in heart rate, oxygen saturation, cerebral oxygenation and cerebral blood volume in preterm neonates, and to identify factors that modulate this relationship.
We searched Medline, EMBASE, PsycINFO, and Cochrane Central Register of Controlled Trials databases and included primary empirical studies examining the relationship between apnoea or respiratory pause duration and at least one outcome in hospitalised neonates with postmenstrual age (PMA) <37 weeks. Through meta-analyses, we prospectively examined factors that may modulate this relationship, including postmenstrual age, medication use, and apnoea type.
Forty-two papers were included, involving a total of 1483 neonates with 2399 study sessions. The decrease in heart rate, oxygen saturation, and cerebral oxygenation were significantly correlated with apnoea duration. PMA significantly modulated the relationship, with younger neonates more likely to exhibit oxygen desaturation from short apnoeas.
Cardiorespiratory and cerebrovascular responses to apnoea are correlated with apnoea duration, yet wide variability exists in the response. Further research is needed to identify how factors modulate the relationship.
Systematic review and meta-analysis of the relationship between apnoea duration and change in heart rate, oxygen saturation, cerebral oxygenation and cerebral blood volume in preterm neonates. Through meta-analysis, we demonstrate that postmenstrual age plays a significant modulating role in the relationship between apnoea duration and change in oxygen saturation, with younger infants more likely to have desaturations. Apnoea can lead to significant cardiorespiratory and cerebrovascular changes; understanding the factors which modulate these relationships are key to facilitating personalised alarm limits.
呼吸暂停是早产儿常见的呼吸并发症，会导致生理上的显著变化。我们进行了这项系统评价和荟萃分析，以研究早产儿呼吸暂停持续时间与心率、血氧饱和度、脑氧合和脑血容量变化之间的关系，并确定调节这种关系的因素。
我们检索了Medline、EMBASE、PsycINFO和Cochrane对照试验中央注册库数据库，并纳入了主要的实证研究，这些研究考察了呼吸暂停或呼吸暂停持续时间与住院的月经后年龄（PMA）<37周的新生儿至少一项结局之间的关系。通过荟萃分析，我们前瞻性地研究了可能调节这种关系的因素，包括月经后年龄、药物使用和呼吸暂停类型。
纳入42篇论文，共涉及1483例新生儿，有2399个研究时段。心率、血氧饱和度和脑氧合的下降与呼吸暂停持续时间显著相关。PMA显著调节了这种关系，较小的新生儿更有可能因短暂呼吸暂停而出现氧饱和度下降。
对呼吸暂停的心肺和脑血管反应与呼吸暂停持续时间相关，但反应存在很大差异。需要进一步研究以确定因素如何调节这种关系。
对早产儿呼吸暂停持续时间与心率、血氧饱和度、脑氧合和脑血容量变化之间关系的系统评价和荟萃分析。通过荟萃分析，我们证明月经后年龄在呼吸暂停持续时间与氧饱和度变化之间的关系中起显著调节作用，较小的婴儿更有可能出现氧饱和度下降。呼吸暂停可导致显著的心肺和脑血管变化；了解调节这些关系的因素是设定个性化警报阈值的关键。
