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Physiological and clinical aspects of respiration control in infants with relation to the sudden infant death syndrome

Physiologische und klinische Gesichtspunkte der Atemregulation bei Säuglingen im Hinblick auf den plötzlichen Kindestod

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Summary

We have examined the behavior of several variables which are related to respiratory control in 114 infants (up to 6 months of age) in order to assess the risk for the sudden infant death syndrome (SIDS). 23 of the infants had already had demonstrable serious or life threatening apneas or respiratory problems during surgical anesthesia. These infants were assigned as a risk group, and the rest of the investigated babies was taken as a control group.

We found that practically all infants of the risk group had apneas during sleep, which lasted longer than 8 s each. Only 22% of the infants of the control group had apneas of such a duration. As a statistical parameter, calculated from at least 1 hour recording of respiration, we defined the mean apnea duration (MA-value) as average value of apnea duration time in seconds per minute of recording. The MA-value proved to be significantly elevated in the infants of the risk group. The trend to hypoxia in the infants of the risk group was also indicated by the observation of lower transcutaneous\(P_{O_2 } \)-values (tc-\(P_{O_2 } \)) during sleep, when compared with control infants. In agreement with this observation is the increase of the 2,3-DPG concentration and the decrease of the density of erythrocytes of the infants of the risk group.

Breathing hypoxic gas mixtures tended to depress respiration in all infants tested, and, especially in the risk group, to elicit irregular respiratory patterns. On the other hand, we observed that inhalation of pure oxygen markedly stimulated respiration in all infants investigated.

We conclude from these observations that a risk for SIDS may be related to a particular response pattern of the respiratory center during the early postnatal life. We are able to distinguish infants with a higher risk for SIDS from other children by determination of the MA-value during sleep.

Zusammenfassung

Wir untersuchten das Verhalten verschiedener Variabler, die mit der Atemregulation bei Säuglingen bis zu einem Alter von 6 Monaten in Verbindung stehen, um ein eventuelles Risiko für das Auftreten eines SIDS-Ereignisses (sudden infant death syndrome) identifizieren zu können. Bei 23 von insgesamt 114 untersuchten Säuglingen waren bereits ernste oder lebensbedrohende Apnoeanfälle während chirurgischer Eingriffe unter Narkose beobachtet worden. Diese Babies wurden als Risikogruppe bezeichnet, während die restlichen untersuchten Säuglinge als Kontrollgruppe galten.

Wir konnten zeigen, daß praktisch alle Risikosäuglinge Apnoen während des Schlafes hatten, die eine Länge von 8 s überschritten. Lediglich 22% aller Kontrollsäuglinge hatten Apnoen dieser Länge. Von den aufgezeichneten Atemkurven berechneten wir als statistischen Parameter den mittleren Atemsausfall in s pro min (MA-Wert). Dieser MA-Wert war bei der Risikogruppe im Vergleich mit der Kontrollgruppe statistisch signifikant erhöht. Durch kontinuierliche Aufzeichnungen der transkutanen\(P_{O_2 } \)-Werte konnte darüber hinaus noch gezeigt werden, daß die Babies der Risikogruppe zu einer Hypoxämie während des Schlafes neigen. Übereinstimmend mit dieser Beobachtung ist auch der Anstieg der 2,3-DPG-Konzentration und der Abfall der Dichte der Erythrocyten bei Risikosäuglingen. Verabreichung leicht hypoxischer Gasgemische führte besonders bei der Risikogruppe

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Authors and Affiliations

  1. Institute of Physiology and Department of Pediatric Surgery, University of Graz, Austria

    R. Haidmayer, R. Kurz, T. Kenner, H. Wurm & K. P. Pfeiffer

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  1. R. Haidmayer
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  2. R. Kurz
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  3. T. Kenner
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  4. H. Wurm
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  5. K. P. Pfeiffer
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Additional information

This study was supported by the Austrian Research Fund zu einer Atemdepression sowie auch zum Auftreten unregelmäßiger Atemmuster. Andererseits aber konnten wir den interessanten Befund erheben, daß reiner Sauerstoff bei allen Säuglingen zu einer Atemstimulation beitrug.

Aus unseren Beobachtungen schließen wir, daß ein Risiko für das SIDS möglicherweise im Zusammenhang mit bestimmten Antwortmustern des Atemzentrums während des frühen postnatalen Lebens steht. Wir können nun zwischen Kindern mit einem hohen und einem geringeren Risiko für das SIDS unterscheiden, indem wir ihre MA-Werte während des Schlafes bestimmen.

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Haidmayer, R., Kurz, R., Kenner, T. et al. Physiological and clinical aspects of respiration control in infants with relation to the sudden infant death syndrome. Klin Wochenschr 60, 9–18 (1982). https://doi.org/10.1007/BF01721582

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  • DOI: https://doi.org/10.1007/BF01721582

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