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Ventilatory response to added dead space and position in preterm infants at high risk age for SIDS.
MedLine Citation:
PMID:  20979143     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: The vulnerability of prematurely born infants to sudden infant death syndrome (SIDS) in the prone position might be explained by a reduced ability to respond to a stress, such as hypercarbia, in that position; our objective, therefore, was to further explore the influence of position on the response to a stress. WORKING HYPOTHESIS: The ability of prematurely born infants to respond to added dead space in the prone compared to the supine position would be impaired at the high risk age for SIDS. PATIENTS: Twenty infants, median gestational age of 30 (range 24-32) weeks were studied at a median postmenstrual age (PMA) of 45 weeks. In addition, comparisons were made to the results of 25 infants studied at 36 weeks PMA. METHODOLOGY: Infants were studied supine and prone. Breath by breath minute volume was measured at baseline and after a dead space was incorporated into the breathing circuit; the time constant of the response was calculated. The pressure generated in the first 100 msec of an occlusion (P(0.1)), the maximum inspiratory pressure during an airway occlusion and functional residual capacity (FRC) were also measured in both positions. RESULTS: The median time constant was longer (38 (range 15-85) vs. 26 (range 2-40) sec (P = 0.002)). P(0.1) lower (P = 0.003) and FRC higher (P = 0.031) in the prone compared to the supine position. In the prone position, the time constant correlated with PMA (P = 0.047), that is, the rate of response to added dead space was significantly damped with increasing postnatal age up to the critical age for SIDS. CONCLUSIONS: The dampened rate of response to added dead space in the prone compared to the supine position lends support to the hypothesis that a poorer response to a stress may contribute to prematurely born infants increased risk of SIDS in the prone position. Pediatr Pulmonol. © 2010 Wiley-Liss, Inc.
Authors:
Tolulope Saiki; Simon Hannam; Gerrard F Rafferty; Anthony D Milner; Anne Greenough
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2010-10-26
Journal Detail:
Title:  Pediatric pulmonology     Volume:  -     ISSN:  1099-0496     ISO Abbreviation:  -     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8510590     Medline TA:  Pediatr Pulmonol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Division of Asthma, Allergy and Lung Biology, MRC-Asthma Centre, King's College London, London, United Kingdom.
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