by perinatologija | Okt 20, 2023 | cmcrf
S pojmom kronična pljučna bolezen (KPB) pri novorojenčkih in dojenčkih zajemamo širok spekter različnih kliničnih stanj. Bronhopulmonalna displazija (BPD) je najpogostejši vzrok in je pogosto povezana z drugimi boleznimi in stanji, kot sta nedonošenost ali obstrukcijska apneja med spanjem (OSA). Zaradi tehničnih omejitev se snemanje dihalnih vzorcev v spanju – polisomnografija (PSG) ali respratorna poligrafija (RP) – v številnih centrih ne izvaja. Oksimetrija in kožno spremljanje ogljikovega dioksida se pogosto uporabljata kot nadomestek za PSG / RP. Indikacije za PSG / RP pri dojenčkih s KPB lahko razdelimo na 6 kliničnih sklopov: a) spremljanje centralne apneje in periodičnega dihanja, b) kratek izzvenel nepojasnjen dogodek pri novorojenčku (KINK), c) obstrukcijska apneja v spanju (OSA), d) odvajanje od kisika, e) spremljanje med ventilacijo in odvajanje od ventilacije, 7) dekanulacija traheostome.
The Role of Polygraphy in Infants with Chronic Lung Disease
Chronic lung disease (CLD) and infants is a broad spectrum of clinical conditions, however, bronchopulmonary dysplasia (BPD) is the most common cause of chronic respiratory insufficiency in infants and is often associated with other comorbidities like prematurity or obstructive sleep apnoea (OSA). Sleep studies are not currently performed in a lot of centres due to technical difficulties. Oximetry and transcutaneous carbon dioxide monitoring are often used as a surrogate of sleep studies. Indications for sleep studies in infants with CLD may be grouped in 6 clinical scenarios: a) central apnoea and periodic breathing monitoring b) brief resolved unexpected event (BRUE) c) OSA d) oxygen supplementation weaning e) ventilatory support monitoring and weaning f) tracheostomy decannulation.
Alessandro Amaddeo
by perinatologija | Okt 20, 2023 | cmcrf
Poligrafija je še vedno zlati standard za ocenjevanje obstruktivnih dihalnih premorov v spanju pri otrocih vseh starostnih skupin. Vendar je podatkov za skupino donošenih, zdravih novorojenčkov malo. Možna koristna uporaba poligrafije se kaže v oceni srčno-dihalnih vzorcev v različnih položajih telesa dojenčka, kot na primer pri preverjanju varnosti otroka v avtomobilskem varnostnem sedežu. Številne raziskave so pokazale, da namestitev dojenčka, še zlasti nedonošenčka, v ta položaj lahko privede do motenj v dihanju. Da bi ugotovili, ali pride do desaturacij tudi ob namestitvi zdravega, donošenega novorojenčka v avtomobilski varnostni sedež (lupinico) ali posteljico, smo v letih 2006 in 2007 izvedli dve veliki prospektivni randomizirani raziskavi v Porodnišnici UKC Ljubljana, Slovenija. Čeprav sta bili raziskavi omejeni, ker so manjkali podatki o fazi spanja med meritvami, smo v primerjavi s položajem v bolnišnični posteljici potrdili pomembne desaturacije tako v varnostnem sedežu kot v posteljici. Desaturacije pri dojenčkih so zaskrbljujoče v luči podatkov, ki kažejo vedenjske težave in kognitivni primanjkljaj tudi po blagih hipoksičnih dogodkih. Ker se avtomobilski sedeži pogosto uporabljajo tudi za druge namene kot za prevoz, so majhni dojenčki, ki so vanje nameščeni dlje časa, izpostavljeni povečanemu tveganju za ponavljajoče se desaturacije ali celo nepričakovano nenadno smrt dojenčka.
Polygraphy in Healthy Term Neonates in Maternity Hospital – Practical Implications in Car Seat Safety Testing
Polygraphy is still the gold standard for the evaluation of obstructive respiratory apnoeas during sleep in children of all ages. However, there are limited data in healthy term infants. A possible beneficial use of polygraphy is the assessment of the cardiorespiratory patterns in different positions of the infant’s body, such as in car safety seat testing. As shown in several studies, placement in the upright position, particularly in infant born preterm, may cause respiratory compromise. We conducted two large prospective randomized studies at the UMC Ljubljana’s Maternity Hospital, in Slovenia in 2006 and 2007 in order to ascertain whether oxygen desaturations also occur when healthy, term infants are positioned in car seats and car beds. Although the studies were limited by a lack of documentation of sleep stage, significant desaturations were observed in both car seats and car beds as compared with hospital cribs. Desaturations in infants are concerning in light of data demonstrating behavioural problems and IQ deficits even after mild hypoxic events. As car safety seats are often used for reasons other than transport, young infants placed in them for prolonged periods of time are at increased risk for recurrent desaturations or even unexpected sudden infant death.
Lilijana Kornhauser Cerar
by perinatologija | Okt 20, 2023 | cmcrf
Pri nedonošenčkih so dihalni premori skoraj edini klinični odraz nezrelega nadzora dihanja. Splošno je sprejeto, da je centralni nadzor glavni dejavnik za njihov nastanek in da gre pri nedonošenčkih ne glede na različne dejavnike za eno entiteto, za katero se je uveljavil izraz apneja zaradi nedonošenosti (angl. Apnea of Prematurity, AOP). Ločimo tri tipe AOP: centralno, obstruktivno in mešano. Najpomembnejša posledica AOP so ponavljajoči se hipoksemični dogodki, ki so povezani s številnimi neugodnimi izidi, kot so retinopatija zaradi nedonošenosti (ROP), bronhopulmonalna displazija (BPD) ter razvojni zaostanek. Na nastanek AOP vplivajo številni dejavniki: nezrelost ali zavora dihalnega centra, stanje budnosti in spanja, vpliv kemoreceptorjev, Hering-Breuerjev refleks, gastroezofagealni refluks in dinamična podajnost zgornjih dihalnih poti, ki so v članku podrobno opisani. Zdravljenje AOP je farmakološko, ki temelji na metilksantinih, in nefarmakološko, kot so uporaba stalnega pozitivnega nadtlaka v dihalnih poteh, nadzorovano mehansko senzorično draženje in uravnavanje primerne zasičenosti krvi s kisikom. Preiskava za opredelitev dihalnih premorov je polisomnografija (PSG), saj vključuje tudi možnosti opredelitve obdobja spanja. Pri nedonošenčkih uporabljamo zmanjšan nabor signalov: EKG, nosni termistor ali kanilo, pulzno oksimetrijo in torakalno induktivno pletizmografijo, kar imenujemo kontinuirano zapisovanje kardiorespiratornih funkcij (CMCRF) ali kar kardiorespiratorna poligrafija (CRPG). V zadnjem delu članka predstavljamo izkušnje s CRPG pri nedonošenčkih v EINT Porodnišnice Ljubljana. Najpogostejše indikacije za CRPG v EINT so pogoste desaturacije, potreba po zdravljenju s kisikom pri otrocih z BPD in ukinitev metilksantinskih preparatov. Med otroki z AOP v EINT pa s 43 % prevladuje obstruktivni tip apneje, mešani tip se pojavlja pri 33 %, centralni pa v 14 %.
Breathing disorders and cardiorespiratory polygraphy in preterm infants – our experiences
In preterm infants, apnoea is a universal manifestation of immature respiratory control. It is widely accepted that central control is the main factor in their occurrence. In preterm infants regardless of various factors, it is a single entity for which the term Apnoea of Prematurity (AOP) has been established. There are three types of AOP: central, obstructive, and mixed. The most important consequence of AOP are intermittent hypoxemic events that are associated with many poor outcomes, such as retinopathy of prematurity, bronchopulmonary dysplasia, and developmental delay. Many factors play a role in the pathogenesis of AOP, including immaturity or inhibition of the respiratory centre, wake-sleep state, chemoreceptors, the Hering-Breuer reflex, gastro-oesophageal reflux, and dynamic compliance of the upper airway. AOP is treated pharmacologically with methylxanthines and non-pharmacologically, using continuous positive airway pressure, of mechanosensory input optimization, and blood gas status optimization. Polysomnography (PSG) is a multichannel test used in sleep-related breathing disorders. A reduced set of signals is used in preterm infants: EKG, nasal thermistor or cannula, pulse oximetry, and thoracic inductive plethysmography, referred to as continuous monitoring of cardiorespiratory functions (CMCRF) or cardiorespiratory polygraphy (CRPG). The final section of the article discusses experiences with CRPG in preterm infants at Ljubljana Maternity Hospital’s NICU. The most common indications for CRPG are frequent desaturations, the need for oxygen therapy in children with BPD, and withdrawal of methylxanthine therapy. Among infants with AOP, the obstructive type of apnoea predominates in 43%, mixed type in 33 %, and central type in 14%.
Tomaž Križnar
by perinatologija | Okt 20, 2023 | cmcrf
Najpogostejši fiziološki signali pri poligrafiji novorojenčkov in dojenčkov so pretok zraka, gibanje prsnega koša, nasičenost arterijske krvi s kisikom, frekvenca srčnega utripa in elektrokardiogram. Odvisno od modela naprave lahko zapisujemo položaj pacienta, premikanje trebuha, elektroencefalogram, elektrookulogram, elektromiogram, pCO2, ali snemamo zvok in sliko z avdio in video snemalnikom. Za merjenje pretoka zraka pri novorojenčkih in dojenčkih priporočajo uporabo nosne kanile ali termistorja.
Physical and Technical Basis of Physiological Signals Capturing and Processing in Cardiorespiratory Polygraphy in Neonates and Infants
The most common physiological signals in neonates and infants polygraphy are airflow, chest movements, arterial blood oxygen saturation, heart rate, and electrocardiogram. Depending on the device model, it is also possible to measure body position, movement of the abdominal part of the body, electroencephalogram, electrooculogram, electromyogram, pCO2, and video and audio monitoring. In neonates it is recommended to use a nasal cannula and a thermistor for flow measurement.
Bojan Bazelj
by perinatologija | Okt 20, 2023 | cmcrf
Dihalni premori pri novorojenčkih so pogosti zlasti pri nedonošenčkih, srečamo pa jih tudi pri donošenih novorojenčkih. Novorojenčki so nagnjeni k dihalnim premorom v spanju zaradi različnih fizioloških posebnosti. Poznavanje normalnih vzorcev dihanja novorojenčkov je pomembno zato, da prepoznamo odstopanja od normale in uvedemo pravi način zdravljenja ali se za zdravljenje niti ne odločimo in se tako izognemo pretirani medikalizaciji in zaskrbljenosti staršev. Zlati standard za oceno dihalnih premorov v spanju je polisomnografija, vendar je v neonatalnem obdobju bolj uporabna nekoliko poenostavljena verzija, tj. poligrafija oz. CMCRF (iz angleščine Continuous Monitoring of Cardio-Respiratory Functions ali kontinuirano zapisovanje srčno-dihalnih vzorcev). Dihalni vzorci pri novorojenčku so odvisni od postkoncepcijske starosti, načina snemanja, trajanja preiskave, intervala povprečenja oksimetrije in definicije dogodka. Centralni dihalni premori in periodično dihanje so v neonatalnem obdobju pogosti, medtem ko so obstrukcijski in mešani dihalni premori redki. Za čim bolj natančne rezultate preiskave moramo skrbno upoštevati navodila za njeno izvedbo, ob interpretaciji pa se je treba držati okvirnih in objavljenih referenčnih vrednosti. V prihodnosti so potrebne še natančnejše raziskave na različnih populacijah novorojenčkov, da bomo lahko bolje ovrednotili, kaj je še normalno, kaj je del razvojnih posebnosti nedonošenih in donošenih novorojenčkov ter kaj predstavlja odstopanje od normale, ki zahteva zdravljenje.
Principles of Polygram Recording and Reading in Neonates – Current Guidelines
Respiratory pauses are especially common in preterm neonates, but can be encountered in term neonates as well. Different physiological characteristics predispose neonates to respiratory pauses during sleep. Knowledge of normal neonatal breathing patterns is important in order to recognize deviations from the norm and choose an appropriate treatment modality, or to avoid treatment altogether and thus avoid overtreatment and parental concern. The gold standard for categorizing sleep disordered breathing is polysomnography; however, in the neonatal period, a simplified version is more appropriate, i.e., polygraphy. Neonatal breathing patterns are influenced by postconceptional age, mode of recording, study duration, oximetry averaging interval, and the definition of an event. Central apnoea and periodic breathing are common in the neonatal period, whereas obstructive and mixed apnoeas are rare. To obtain the most accurate results, we must strictly adhere to the study protocol and follow indicative as well as published reference values in interpretation. Getting a better understanding of what is still normal, what is part of the developmental characteristics of preterm and term neonates, and what is not normal to the extent that treatment is necessary requires more precise studies in different neonatal populations in the future.
Tina Perme
