Relationship between apnoea and bradycardia in preterm infants

Abstract

Nine studies were carried out on seven babies who were having repeated episodes of bradycardia without any clinically obvious apnoea. Their mean gestational age was 31.7 weeks (range 29 to 36 weeks) and the mean birth weight was 1.56 kg (range 1.08 kg to 2.16 kg). Investigations were carried out in a total body plethysmograph. Face mask with a pneumotachograph attached to it measured flow. Tidal volume was obtained by integrating these signals. An oesophageal balloon measured intrathoracic pressure changes and the heart rate was measured from ECG chest electrodes. A total of 172 episodes of apnoea were observed. In 50% of these apnoeas, the airway was closed as determined by the absence of cardiac artefact on the flow signals. Apnoea was associated with bradycardia in just over 25% of all apnoea. It tended to occur early (11 to 14 sec). Whether the apnoea was central or obstructive had no effect on the pattern provided the baby did not make any inspiratory efforts. Inspiration against a closed airway produced bradycardia in over 50% of obstructive apnoea, the heart rate falling precipitously within 1 to 2 sec. These findings indicate that often bradycardias occur too early in apnoea to be due to central hypoxia and must be due to a peripheral mechanism.