Curzi-Dascalova L, Peirano P, Christova E
INSERM, Hopital Robert Debré, Paris, France.
Pediatrics. 1996 Apr;97(4):554-9.
Small-for-gestational age (SGA) infants born with intrauterine growth retardation (IUGR) differ from appropriate-for-gestational age (AGA) infants by: a) alterations in a number of neurologic and neurophysiologic characteristics; b) modified heart rate variability during the neonatal period; and c) increased morbidity rates during the first months of life. However, there are no data on the impact of IUGR on respiratory function at birth.
We studied newborns who were 35 to 36, 37 to 38, and 39 to 41 weeks' conceptional age (CA): 31 were AGA and 26 were SGA. All were clinically and neurologically normal at birth and none exhibited abnormal events during the first year of life. Polygraphic recordings were performed between two meals during the normal postnatal stay in the maternity ward.
During both active sleep (AS) and quiet sleep (QS), SGA infants in all CA groups had significantly higher values for the incidence of 2 to 4.9 seconds and 5 to 9.9 seconds central respiratory pauses (RP), the apnea index (AI) [AI=% of nonbreathing time], and the time spent with periodic breathing (PB), as compared with AGA infants. Respiratory frequency was usually similar in SGA and AGA infants. In addition, the trend of age-related respiratory modifications was disturbed in SGA infants, as compared with AGA infants: at 39 to 41 weeks CA, SGA infants had no significant decreases in RP, AI, or PB, and no increase in respiratory frequency. However, between-state differences were similar in both groups. In all AGA and SGA infant groups respiratory frequency seemed to be an individual characteristic: infants who breathed faster during AS breathed faster during QS, and vice-versa.
Our data demonstrate significant modifications in the establishment of respiratory rhythm control in SGA infants, whereas the patterns of state-related and subject-dependent breathing characteristics were similar in SGA and AGA infants. We speculate that the dysregulation of respiratory function control maturation observed in healthy SGA infants may be related to subtle brainstem modifications attributable to the decreased blood supply and chronic hypoxia associated with IUGR.
出生时患有宫内生长受限（IUGR）的小于胎龄（SGA）婴儿与适于胎龄（AGA）婴儿存在以下差异：a）一些神经和神经生理学特征发生改变；b）新生儿期心率变异性改变；c）出生后最初几个月发病率增加。然而，尚无关于IUGR对出生时呼吸功能影响的数据。
我们研究了孕龄（CA）为35至36周、37至38周和39至41周的新生儿：31例为AGA，26例为SGA。所有婴儿出生时临床和神经方面均正常，且在出生后第一年未出现异常情况。在产科病房正常产后住院期间，于两餐之间进行多导记录。
在所有CA组的SGA婴儿中，与AGA婴儿相比，在主动睡眠（AS）和安静睡眠（QS）期间，2至4.9秒和5至9.9秒的中枢呼吸暂停（RP）发生率、呼吸暂停指数（AI）[AI = 无呼吸时间的百分比]以及周期性呼吸（PB）持续时间均显著更高。SGA和AGA婴儿的呼吸频率通常相似。此外，与AGA婴儿相比，SGA婴儿与年龄相关的呼吸变化趋势受到干扰：在39至41周CA时，SGA婴儿的RP、AI或PB无显著降低，呼吸频率也无增加。然而，两组的状态间差异相似。在所有AGA和SGA婴儿组中，呼吸频率似乎是个体特征：在AS期间呼吸较快的婴儿在QS期间呼吸也较快，反之亦然。
我们的数据表明SGA婴儿在呼吸节律控制的建立方面存在显著改变，而SGA和AGA婴儿与状态相关和个体相关的呼吸特征模式相似。我们推测，在健康SGA婴儿中观察到的呼吸功能控制成熟失调可能与IUGR相关的血液供应减少和慢性缺氧导致的脑干细微改变有关。
