BACKGROUND: Periodic breathing (PB) is a normal immature breathing pattern in neonates that, if extreme, may be associated with pathologic conditions. METHODS: We used our automated PB detection system to analyze all bedside monitor chest impedance data on all infants < 35 wk' gestation in the University of Virginia Neonatal Intensive Care Unit from 2009-2014 (n = 1,211). Percent time spent in PB was calculated hourly ( > 50 infant-years' data). Extreme PB was identified as a 12-h period with PB > 6 SDs above the mean for gestational age (GA) and postmenstrual age and > 10% time in PB. RESULTS: PB increased with GA, with the highest amount in infants 30-33 wk' GA at about 2 wk' chronologic age. Extreme PB was identified in 76 infants and in 45% was temporally associated with clinical events including infection or necrotizing enterocolitis (NEC), immunizations, or caffeine discontinuation. In 8 out of 28 cases of septicemia and 10 out of 21 cases of NEC, there was a > 2-fold increase in %PB over baseline on the day prior to diagnosis. CONCLUSION: Infants < 35 wk GA spend, on average, < 6% of the time in PB. An acute increase in PB may reflect illness or physiological stressors or may occur without any apparent clinical event.
Patel, Manisha; Sinkin, Robert A.; Kattwinkel, John; Mohr, Mary; and Delos, John, Clinical associations with immature breathing in preterm infants: part 2-periodic breathing (2016). PEDIATRIC RESEARCH, 80(1), 21-27.