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Diaphragmatic electromyography in infants: an overview of possible clinical applications

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Abstract

Preterm infants often experience breathing instability and a hampered lung function. Therefore, these infants receive cardiorespiratory monitoring and respiratory support. However, the current respiratory monitoring technique may be unreliable for especially obstructive apnea detection and classification and it does not provide insight in breathing effort. The latter makes the selection of the adequate mode and level of respiratory support difficult. Electromyography of the diaphragm (dEMG) has the potential of monitoring heart rate (HR) and respiratory rate (RR), and it provides additional information on breathing effort. This review summarizes the available evidence on the clinical potential of dEMG to provide cardiorespiratory monitoring, to synchronize patient-ventilator interaction, and to optimize the mode and level of respiratory support in the individual newborn infant. We also try to identify gaps in knowledge and future developments needed to ensure widespread implementation in clinical practice.

Impact

  • Preterm infants require cardiorespiratory monitoring and respiratory support due to breathing instability and a hampered lung function.

  • The current respiratory monitoring technique may provide unreliable measurements and does not provide insight in breathing effort, which makes the selection of the optimal respiratory support settings difficult.

  • Measuring diaphragm activity could improve cardiorespiratory monitoring by providing insight in breathing effort and could potentially have an important role in individualizing respiratory support in newborn infants.

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Fig. 1: The dEMG-related parameters.

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Authors and Affiliations

  1. Department of Neonatology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands

    Anouk W. J. Scholten, Ruud W. van Leuteren, Cornelia G. de Waal, Juliette V. Kraaijenga, Frans H. de Jongh, Anton H. van Kaam & Gerard J. Hutten

  2. Amsterdam Reproduction & Development research institute, Amsterdam, the Netherlands

    Anouk W. J. Scholten, Ruud W. van Leuteren, Cornelia G. de Waal, Juliette V. Kraaijenga, Anton H. van Kaam & Gerard J. Hutten

  3. Faculty of Science and Technology, University of Twente, Drienerlolaan 5, Enschede, the Netherlands

    Frans H. de Jongh

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A.S. wrote the first version of the manuscript. A.S., R.v.L., F.d.J., C.d.W., J.K., A.v.K., and J.H. modified the manuscript. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Gerard J. Hutten.

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Scholten, A.W.J., van Leuteren, R.W., de Waal, C.G. et al. Diaphragmatic electromyography in infants: an overview of possible clinical applications. Pediatr Res 95, 52–58 (2024). https://doi.org/10.1038/s41390-023-02800-1

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