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Review
. 2019 Sep;46(3):553-565.
doi: 10.1016/j.clp.2019.05.006. Epub 2019 Jun 15.

Intermittent Hypoxemia in Preterm Infants

Juliann M Di Fiore  1 , Peter M MacFarlane  2 , Richard J Martin  2
Affiliations
Review

Intermittent Hypoxemia in Preterm Infants

Juliann M Di Fiore et al. Clin Perinatol. 2019 Sep.

Abstract

Intermittent hypoxemia (IH) events are common during early postnatal life, particularly in preterm infants. These events have been associated with multiple morbidities, including retinopathy of prematurity, sleep disordered breathing, neurodevelopmental impairment, and mortality. The relationship between IH and poor outcomes may depend on the patterns (frequency, duration, and timing) of the IH events. Current treatment modalities used in the clinical setting have been only partially successful in reducing the incidence of apnea and accompanying IH, but the risks and benefits of more aggressive interventions should include knowledge of the relationship between IH and morbidity.

Keywords: Hypoxia; Intermittent hypoxemia; Neurodevelopmental impairment; Outcomes; Pulse oximetry; Retinopathy of prematurity.

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Figures

Figure 1.
Figure 1.
The progression of intermittent hypoxemic events (IH) during early postnatal life. Preterm infants exhibit relatively few IH during the first week of life followed by an increase during weeks 2–4 and a decrease thereafter. From Di Fiore JM, Bloom JN, Orge F, et al. A higher incidence of intermittent hypoxemic episodes is associated with severe retinopathy of prematurity. The Journal of pediatrics. Jul 2010;157(1):69–73
Figure 2.
Figure 2.
The relationship between intermittent hypoxemia and outcomes may be dependent on the pattern of the hypoxemic events. IH have been associated with morbidity in preterm infants but not all IH have been shown to have deleterious effects. Therefore, these studies may represent “severe” IH in terms of frequency, severity, duration and timing that induce inflammation, neurotransmitter imbalance and reactive oxygen species with a high risk of poor outcomes. In contrast, the effect of “mild” IH on outcomes is unclear.
Figure 3.
Figure 3.
Treatment strategies for intermittent hypoxemia include a multi-pronged approach; xanthines to enhance respiratory control, supplemental oxygen and pressure support to optimize baseline level of oxygenation and red blood cell transfusion to improve oxygen stores.
See this image and copyright information in PMC

References

    1. Gleason CA, Martin RJ, Anderson JV, Carlo WA, Sanniti KJ, Fanaroff AA. Optimal position for a spinal tap in preterm infants. Pediatrics. January 1983;71(1):31–35. - PubMed
    1. Rome ES, Stork EK, Carlo WA, Martin RJ. Limitations of transcutaneous PO2 and PCO2 monitoring in infants with bronchopulmonary dysplasia. Pediatrics. August 1984;74(2):217–220. - PubMed
    1. Solimano AJ, Smyth JA, Mann TK, Albersheim SG, Lockitch G. Pulse oximetry advantages in infants with bronchopulmonary dysplasia. Pediatrics. November 1986;78(5):844–849. - PubMed
    1. Ramanathan R, Durand M, Larrazabal C. Pulse oximetry in very low birth weight infants with acute and chronic lung disease. Pediatrics. April 1987;79(4):612–617. - PubMed
    1. Brockmann PE, Wiechers C, Pantalitschka T, Diebold J, Vagedes J, Poets CF. Under-recognition of alarms in a neonatal intensive care unit. Archives of disease in childhood. Fetal and neonatal edition. November 2013;98(6):F524–527. - PubMed

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