Search

Objective: To measure the accuracy of a novel device in detecting Bradycardia andDesaturation (B&D) events and to determine its efficacy in resolving apneas innewborns with comparison to standard monitor (which only detects B&D eventsand alerts).Design: This was a prospective observational study.Setting: Sick Newborn Care Unit of a large tertiary referral hospital in Hyderabad,India.Methods: 31 newborns were provided with a novel device, which monitored oxygensaturation and pulse rate and alarmed when values dropped below a set thresholdwhich is referred as an event, henceforth. The novel device also provided footstimulation in response to above-mentioned events. When the monitor alarmed, anurse attended to the baby to confirm whether the baby was breathing and whetherthe event had been resolved by the device. If the event had not resolved, appropriateaction as per the standard-of-care was performed.Results: The novel device “ApneBootTM” positively detected B&D events 94.03% oftimes as compared to the standard reference monitor. 56 of 67 observed B&D eventswere visually confirmed to be apneas, indicating that 83.6% of B&D eventscoincided with apneas. Of the 56 apneic events, 50 were central apneas, of which 35were resolved by the novel device, making the device’s efficacy of apnea resolution70%.Conclusion: The results of the study indicate that this novel device “ApneBootTM”is very effective in detecting and alarming B&D events, which coincides with theapnea, and resolving it by providing foot stimulation.Keywords: Novel Device, Neonatal Apnea, Low Birth Weight, Body Temperature,Kangaroo Mother Care, Community Health

OBJECTIVES: First, to determine the feasibility of an ultra-compact wireless device (microEEG) to obtain multichannel electroencephalographic (EEG) recording in the Neonatal Intensive Care Unit (NICU). Second, to identify problem areas in order to improve wireless EEG performance. STUDY DESIGN: 28 subjects (gestational age 24–30 weeks, postnatal age

OBJECTIVE: To determine the maternal perinatal morbility and mortality in the first pregnancy of the older women. MATERIAL AND METHODS: Retrospective and transversal study of 133 older women 35 years old or more who had their first pregnancy attended at Cayetano Heredia National Hospital between january 1st and december 31th 1996. They were compared with 5,006 women who had their first pregnancy at of 20 to 29 years old and attended in the same period of time. RESULTS: The incidence of maternal pathology is more frequent in the first pregnancy of older women with a relative risk (RR) 8,55 for previous arterial hypertension, 2,49 for eclampsia, 1,39 for pre eclampsia, 2,18 for cephalopelvic disproportion and 2,03 for hemorragia of third trimester of pregnancy. Cesarean section has a relative risk of 2,55. For the newborn the relative risk is highter for hyalina membrane (4,09), neonatal apnea (3,47), hyperbilirrubinemia (3,71), and congenital defects (1,5). The maternal mortality rate in older women was 751,9 x 100, 000 newborns and the rate for women 20 to 29 years was 172,3. The perinatal mortality rate type I was 29,6 per 1,000 newborns for the women and 19,6 in these women 20 to 29 years.

This study explored the feasibility effect and safety of the limb stimulation (LS) for the treatment of neonatal apnea (NAP). The cases of 30 eligible premature infants with NAP were included in this retrospective study. These cases were equally divided into an intervention group (n = 15) and a control group (n = 15). The infants in both groups received caffeine treatment. Moreover, cases in the intervention group also received LS for a total 30 hours, while the subjects in the control group did not receive LS during this period. The primary outcome included apnea frequency (number of episodes per 24 hours), and apnea rate. The secondary outcomes consisted of desaturation (number of episodes per 24 hours), and heart rate (beats per minute). Additionally, adverse events were also documented during the treatment period. After treatment, LS did not show better outcomes in apnea frequency (P = .48), apnea rate (P = .33), desaturation (P = .55), and heart rate (P = .41). Furthermore, no significant differences of all adverse events were found between 2 groups. The results of this pilot study demonstrated that LS might be not efficacious for premature infants with NAP.

Objective: To describe common etiologies and diagnostic evaluations performed on term and late preterm neonates with neonatal apnea and to compare these etiologies and evaluations with those infants with infantile acute life threat ening event (ALTE). Methods: Infants 35 weeks, with diagnosis of apnea or ALTE were identified at Bo ston Children's Hospital from June 2000 to June 2009. Medical rec ords were reviewed for diagnostic evaluations and discharge diagnoses. For analysis, neonates who presented with neonatal apnea within the first week of life and prior to discharge f rom the birth hospitalization were classified as the Inpatient Grou p and infants who presented with apnea post discharge were identified as the Outpatient Group. Infants with clear presenting etiologies were excluded from the study. Results: One hundred otherwise healthy subjects with diagnosis of apnea or ALTE in the study period were identified. Approxi- mately one third were classified as the Inpatient Group. Diag nostic evaluations were highly variable, but testing for ba cterial or viral sepsis was most commonly performed. In most cases, an etiology was not determined, and the diagnosis of "apnea of imma- turity" was assigned. Other defined etiologic diagnoses inc luded viral infection or pertussis, reflux/aspiration, lar yngomalacia, and seizures. Conclusions: Diagnostic evaluation for apnea, in otherwise well-appearing full-term and late preterm infants, remains highly variable. Testing for infection, seizure, laryngomalacia and reflux may determine the majority of treatable etiologie s. Guidelines for diagnostic evaluations and treatment strategies are cl early needed.

Theophylline is an extremely potent drug that was once the mainstay of therapy for asthma int he United States. Over the last 2 decades, use of theophylline has decreased markedly as safer, more effective bronchodilators have been created. However, theophylline remains commonly used outside this country. Even in the United States, it continues to have a role in the management of neonatal apnea and moderate-to-severe asthma. With the guarantee of theophylline's continued use, it is essential for clinicians to recognize the causes, manifestations, and consequences of theophylline intoxication. This report provides such a summary, along with currently recommended practice guidelines for the treatment of theophylline poisoning.

Although a significant bibliography exists on the application of signal processing methods to ECG signals, the optimal configuration of these methods so as to maximize their performance on clinical data is a complex problem that is seldom covered in the literature. This is particularly the case for the signal processing chains proposed for the detection and segmentation of individual beats, which are often characterized by a significant number or parameters (filter cut-off frequencies, thresholds, etc.). In this chapter we propose an automated method, based on evolutionary computing, to optimize these parameters in a joint fashion. A brief state of the art on current ECG segmentation methods is presented and a complete signal processing chain, adapted to the detection and segmentation of ECG signals is proposed. The evolutionary optimization method is described and applied to two different monitoring applications: the detection of myocardial ischemia episodes on adult patients and the characterization of apnea-bradycardia events on preterm infants.

Pediatric breathing control disorders can be disastrous if not promptly recognized and treated. Diagnostic techniques and management options are discussed in the context of essential clinical features of five major entities: neonatal apnea, obstructive sleep apnea, central hypoventilation syndrome, "apparent life-threatening events," and sudden infant death syndrome.

Premature infants are susceptible to apnea. Presently physical stimulation, administered to interrupt apneic episodes, is accomplished by hand contact, which is often delayed and presents infection risks. This study developed a software system to collect and analyze data to study the efficacy and safety of mechanical vibrotactile stimulation (VTS) as a means of interrupting an apneic episode. This software system was utilized to compare VTS (n=12) and hand stimulation (n=12). VTS and traditional hand stimulation were found to be equally effective in terminating apnea (9/12 (75%) vs. 10/12 (80%)). Mean time to resumption of breathing from onset of stimulation was similar (VTS 3.1/spl plusmn/2.6 seconds vs. hand 3.7/spl plusmn/4.1 seconds, p=0.67), as was total apnea duration (VTS 28.1/spl plusmn/12.1 seconds vs. hand 28.5/spl plusmn/5.2 seconds, p=0.93). The duration of VTS was half as long as hand stimulation (VTS 2.9/spl plusmn/1.7 seconds vs. hand 6.8/spl plusmn/5.4 seconds, p=0.05). No adverse effects of VTS were noted Overall, VTS was similar to hand stimulation in its ability to end apneic spells. Since the duration of VTS was half that of hand stimulation VTS seems more efficient in interrupting apnea.

161 Prenatal Nicotine Exposure Increases the Risk of Neonatal Apnea -A National Birth-Cohort Study

Currently the classification of neonatal apnea relies upon an inference of airway closure based upon the presence of breathing efforts against such an obstruction. In this study we evaluate a new method of classification which utilizes the presence or absence of cardiac airflow oscillation to detect airway closure. Specifically, this evaluation consisted of an examination of the transmission characteristics of an artificially produced airflow oscillation through discrete airway narrowing in a model system; a confirmation that voluntary upper airway occlusion in adult volunteers uniformly induces complete loss of the oscillation; and a comparison of the cardiac oscillation method with the traditional method of apnea classification in a cohort of 4,309 apneas in 32 infants. We determined that the amplitude of the oscillation is negatively correlated with resistance (r = 0.97) and positively with the radius (r = 0.98) of narrowing in a model system, and that voluntary airway obstruction in adult subjects uniformly results in loss of transmitted cardiac oscillations. Moreover, although there was similarity in the frequency distribution of central, obstructive, and mixed apneas in our infants, there were statistically significantly greater obstructive events detected by the cardiac oscillation method. In addition, the cardiac oscillation method had the additional advantage of providing information regarding the timing of airway obstruction during apnea.

• Analyses were undertaken to determine the causes of cerebral palsy in a prospective study of 43 437 full-term children. Presumed causes were found for about 71% of the 34 quadriplegic and 40% of the 116 nonquadriplegic patients with cerebral palsy. Risk estimates based on predictive models, adjusted for multiple factors, suggest that 53% of the quadriplegic patients with cerebral palsy could be attributed to congenital disorders, 14% to birth asphyxia, and 8% to other identified disorders. Thirty-five percent of the nonquadriplegic patients with cerebral palsy could be attributed to congenital disorders and 6% to other disorders. In the victims of cerebral palsy, characteristic consequences of birth asphyxia were more often the result of nonasphyxial disorders. These included meconium in the amniotic fluid, low 10-minute Apgar scores, neonatal apnea spells, seizures, persisting neurologic abnormalities, and slow head growth after birth. ( AJDC . 1989;143:1154-1161)

Neonatal apnea is a disorder with many possible etiologies and a wide range of severity. Apnea can be an expected complication of prematurity, or it can be the first sign of a lifethreatening disorder, such as sepsis or pulmonary disease. It is the responsibility of the clinician to evaluate the patient thoroughly for associated disorders, to treat any disorders detected, and then to introduce preventative therapies for apnea in the order that will produce the desired benefit at the lowest possible risk of morbidity for the patient.

APNEIC ATTACKS in the preterm infant have recently received widespread attention in the medical literature. Physiologists have presented new data regarding the pathogenesis of this disorder, and clinicians have proposed many new forms of therapy. Frequently, however, a new treatment regimen becomes incorporated into nursery routine without regard for alternative, perhaps less invasive, modes of treatment, and often without consideration of the cause of apnea. It is the purpose of this report to review recent concepts regarding the pathogenesis of neonatal apnea and to propose a treatment schema based on counteracting the supposed physiologic aberrations with a minimum of risk.

The physiologic factors that predispose premature infants to apnea are reviewed in this article. Management and treatment of "idiopathic apnea" are discussed. "Symptomatic apnea" should be treated according to its primary cause.

Growth, neurologic, and ophthalmologic assessments were done in 21 low-birth-weight infants given caffeine for neonatal apnea and in 21 matched control infants. Caffeine significantly decreased the need for and the duration of mechanical ventilation. No difference in growth and development was noted between the control and caffeine-treated infants. A high incidence of cicatricial retrolental fibroplasia was observed in both control (10/21) and caffeine-treated infants (7/18).

The role of perinatal events in producing defect has long aroused both interest and controversy. Recently, attention has centered on those perinatal experiences which reduce the oxygen supply and lead to anoxia or asphyxia. * That anoxia can cause death is not doubted. The question is whether or not, if the organism survives, there are permanent residual effects. The present study was undertaken to determine what residual effects, if any, follow perinatal anoxia in the human organism. Essentially, the procedure consisted of studying a number of newborn infants and then reexamining them at the age of 3 years. The original sample consisted of 717 newborn infants, gathered over a period of two and one-half years. Of this group, 421 were chosen for the three-year follow-up study. Children were excluded if they had mild or questionable complications or congenital defects, or if they had not been born on the inpatient service of

The developmental sequelae of perinatal anoxia have been investigated and reviewed by numerous authors. In view of the potential vulnerability of the central nervous syste~m at the moment of birth, various circumstances, which in one way or another reduce oxygen supply to nervous tissue, have been implicated as causative factors leading to a host of later developmental disturbances. Mental retardation, behavior disorders, learning problems, and neurological defects ranging from cerebral palsy to impaired vision have all been studied in relation to delayed onset of respiration at delivery and/or reduced oxygen supply to the fetus as a result of obstetrical complications such as premature separation of the placenta. It is not surprising that, given the methodological and conceptual complexities of this problem, the findings are varied and, at times, contradictory. Bailey (3) has presented a comprehensive review of the literature. Within the general category of human clinical studies, he distinguishes three classes of research design: In the retrospective study, a sample of damaged, disturbed, or defective individuals is chosen, sometimes paired with matched controls. The investigator then seeks out the birth records of these individuals and determines whether a significantly greater proportion of them were reported as being anoxic at birth than would be found or expected in a normal population. In the prospective-retrospective study, the sample is selected by examining existing birth records to find two contrasting groups, one having sustained

It is speculated that measurement of serum theophylline concentration alone, without concomitant caffeine level determination, may lead to a false negative (normal) pneumocardiogram due to possible existence of therapeutic caffeine level resulting from the methylation of theophylline. Treatment of neonatal apnea with theophylline as documented by a normal follow-up pneumocardiogram should be considered successful only when the levels of both theophylline and caffeine have been documented subtherapeutic at time of re-test.

Approximately 25% of infants with birth weights less than 1800 g or infants of about 34 weeks gestational age have an apneic episode. This, and the known high incidence of apneas in infants who subsequently are victims of sudden infant death syndrome, has led to aggressive attempts at early identification of newborns with abnormal cardio-respiratory patterns. We have found the pneumocardiogram to be effective in detecting cardio-respiratory abnormality in the newborn, and a very useful tool in the assessment of the effectiveness of pharmacologic therapy of neonatal apnea. Infants who are discharged on a home apnea monitor should be managed, utilizing a coordinated multidisciplinary team approach, that includes 24 h availability of a physician, technician, community health nurse, social worker and, when possible, a member of a parent support group. This paper presents a review of neonatal apnea and our institutional approach to its evaluation and management.

Theophylline and caffeine are both effective stimulants of the central nervous system for the therapy of neonatal apnea. Both drugs are slowly eliminated from the body, and doses should be adjusted to account for this slow elimination. Interconversion of theophylline and caffeine occurs in the newborn infant, with the methylation of theophylline to caffeine as the probable predominant pathway. Caffeine may offer advantages over theophylline: wider therapeutic index, case of administration, less need for therapeutic drug monitoring, less fluctuation in plasma concentrations, and fewer peripheral effects. A major disadvantage of caffeine is in the lack of a readily available commercial preparation. Both drugs exert many pharmacologic actions that require further evaluation in the newborn infant. Long-term effects of these drugs administered during a critical period in the developing human remains an area of concern.

Twelve hour PCG was performed on 372 high risk infants (inf) [Resp Care 28:1569, 1983] from 7/1/82 - 6/30/83. Gestational age (mean±SD) was 33.6±3.8 wks and birth wt. was 2262±843.3 gms. 208 inf (Table) have normal PCGs and 144 have abnormal PCGs. PCG was normal at 38.7±3.0 wks among inf on theophylline (T) compared to inf (41.1±6.5 wks) who were not on T (p

Doxapram (Dox), a respiratory stimulant in neonatal apnea, has a short pharmacologio effect (

Sir.—Based on their timing and apparently benign outcome, Duffty and Bryan1have suggested that the cause of episodes of apnea occurring in full-term infants in the first week of life is related to events in the perinatal period. We reviewed one year's experience (July 1, 1984, to June 30, 1985) with full-term infants referred for episodes of apnea, bradycardia, and/or cyanosis that occurred in the first week of life, concentrating on perinatal factors. Data presented herein suggest that infant exposure to prescribed opioids in breast milk might be a causative factor. Patients and Methods.—Selection criteria were as follows: (1) the infant was born at full term (≥37 weeks); (2) the first episode of apnea (>20 s), bradycardia (rate