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Position and ventilatory response to added dead space in prematurely born infants
Author(s) -
Rao Harish,
Saiki Tolulope,
Landolfo Francesca,
Smith Adam P.R.,
Hannam Simon,
Rafferty Gerrard F.,
Milner Anthony D.,
Greenough Anne
Publication year - 2009
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.21021
Subject(s) - supine position , medicine , dead space , prone position , anesthesia , gestational age , sudden infant death syndrome , pediatrics , mechanical ventilation , pregnancy , biology , genetics
Objectives Prematurely born infants are at increased risk of sudden infant death syndrome (SIDS) if slept prone. Working Hypothesis Prematurely born infants would have an impaired response to an added dead space and lower respiratory muscle strength in the prone compared to the supine position. Study design Prospective study. Patient‐Subject Selection Twenty‐five infants, median gestational age of 30 (range 26–32) weeks. Methodology The infants were studied supine and prone at a median of 36 weeks postmenstrual age. 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 maximum inspiratory occlusion pressure generated (MIOP) and the pressure generated over the first 100 msec (P 0.1 ) during airway occlusion were assessed. Results The median time constant was longer (26 (range 8–106) sec vs. 22 (range 6–92) sec ( P = 0.045)) and the median MIOP ( P = 0.001) and P 0.1 ( P = 0.003) were lower in the prone compared to the supine position. Conclusion Prematurely born infants have a dampened response to tube breathing and reduced respiratory muscle strength in the prone compared to the supine position, which may contribute to their increased vulnerability to SIDS in the prone position. Pediatr Pulmonol. 2009; 44:387–391. © 2009 Wiley‐Liss, Inc.