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Article Reviews and Commentary

The Effect of Supplemental Oxygen on Apnea and Sleep in Preterm Infants.
Simakajornboon N, Beckman RC Mack C et al. Pediatrics 2002;110:884-888

Prior studies on cardiorespiratory events in preterms have been done previously, showing conflicting results. In some cases there was resolution of apnea of prematurity and periodic breathing once oxygen concentration was increased to a threshold level. In other investigations, administration of oxygen had contradictory effects on sleep patterns (REM and non-REM sleep) of ex-preterms.

These authors studied 23 ex-preterms infants, born at 30+/- 2 weeks when they were 38 +/- PCA. The infants studied were generally well and ready for discharge for the nursery, having had no cardiorespiratory event within the week prior to being studied. Infants with craniofacial anomalies, genetic diseases, grade 3 or 4 IVH, CLD or neuromuscular diseases were excluded from this study. The infants were given RA or oxygen at 0.25 L/min via nasal cannula.

The infants given oxygen (SupOx group) had decreases in apnea index from 11 events/hr to 3.8 events/hr compared to the RA group. Apnea lasting > 5 seconds was scored. The time spent in periodic breathing was also less in the SupOx group compared to the RA group (6.7% to 1.8%). The SupOx group also had fewer bradycardiac events, 0.3 events vs 2.5 events, compared to the RA group. Measured SpO2 was higher in the SupOx group, 89.7% vs 96.4%, but measures of alveolar ventilation did not differ between the two groups.

Sleep was also affected by the administration of oxygen, with the time spent in quiet sleep increasing from 26.6% in the RA group to 33.3% in the SupOx group.

Commentary Thomas J. Mancuso, MD, FAAP

The authors concluded that a larger multicenter study of the use of supplemental oxygen might lead to improved cardiorespiratory stability, growth and developmental outcome. For pediatric anesthesiologists, the administration of supplemental oxygen for a short period following anesthesia in an infant at risk for post-anesthetic apnea is an appealing therapy. Caffeine, another medication shown to be effective in decreasing the frequency of post-anesthetic apnea, certainly has its share of side effects. This untested and unstudied intervention should not be undertaken lightly in infants at risk for post-anesthetic apnea, however. After discussion with our colleagues in newborn medicine supplemental oxygen might be a useful therapy for infants at risk for post-anesthetic apnea.

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