Home monitoring of transcutaneous oxygen tension in the early detection of hypoxaemia in infants and young children

Article Abstract:

Factors associated with an increased risk for sudden infant death syndrome (SIDS) include a bluish coloration to the skin (cyanosis), lung or heart problems requiring the infant to be resuscitated, premature birth (before week 32 of pregnancy), and having a brother or sister who died from SIDS. Several different types of electronic devices are available for home use for monitoring infants at risk for SIDS. These electronic devices are designed to sound an alarm if the infant stops breathing or the heart rate decreases. However, many infants have died at home even when these devices are used. This is because by the time the infant stops breathing or the heart rate decreases, it is usually too late to do any good. One cause of sudden death in infants is severe hypoxemia, which is a reduction in the amount of oxygen in the blood that causes the infant to turn blue. This can occur in the early stages of sudden death, and it can occur before breathing stops. Therefore, a device that monitors the amount of oxygen in the blood may be able to prevent the infant from dying. Twenty-three infants at risk for sudden death were monitored at home using a device that measures the amount of oxygen in the blood (a transcutaneous oxygen tension monitor, TcPo2). Sixteen of the 23 infants had a total of 69 episodes of hypoxemia or cyanosis. The TcPo2 monitor identified hypoxemia and sounded an alarm during all 69 episodes. Breathing stopped during only seven of the episodes and resuscitation was required in two of the episodes. In another part of the same study, 350 infants at risk for SIDS were monitored at home with a TcPo2 monitor. The monitor identified episodes of hypoxemia in 81 of the patients, 52 of whom required resuscitation. These findings indicate that TcPo2 is a sensitive method for monitoring oxygen in the blood of infants at risk for SIDS. However, as of yet there is no evidence that the TcPo2 monitor will reduce the incidence of SIDS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Diagnosis, Prevention, Hypoxia, Anoxia, Sudden infant death syndrome, Transcutaneous blood gas monitoring

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Breathing patterns and heart rates at ages 6 weeks and 2 years

Article Abstract:

Heart rates and breathing patterns in infants have frequently been analyzed. The incidence of apneic pauses, periods during which infants do not breathe, decreases during the first six months, but the frequency of pauses after that age has not been well studied. Infants who have frequent apneic pauses, probably related to abnormal regulation of breathing, are often considered to be at risk for sudden infant death syndrome and families are supplied with home monitors which sound an alarm if apnea persists 15 seconds or more. However, some prospective studies have not shown an association between prolonged apnea and risk for sudden infant death syndrome. In addition, normal breathing patterns beyond the first six months are not well understood. Heart rates and breathing patterns in 42 healthy infants (20 female and 22 male) were evaluated at six weeks and two years. Two-year-old children had significantly lower heart and respiratory rates. Apneic pauses were present in all the children. Periodic apnea occurred in 29 infants at 6 weeks and in 28 children at 2 years. The average total duration of apnea was similar in the two age groups. Although the frequency of apneic pauses was significantly lower in the older group, the average duration was significantly longer and in some children was over 15 seconds. Children of either age who had more isolated apneic pauses also tended to have more periodic apnea (a sequence of three or more pauses, each separated by 20 seconds). The study suggests that the proportion of time spend in periodic apnea was similar in both groups. The mechanism underlying increased duration of apnea at two years is unclear, but this effect should be kept in mind when apnea in older children is being considered. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Demographic aspects, Infants, Heart beat, Heart rate, Respiration, Apnea

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Sleep related upper airway obstruction in a cohort with Down's syndrome

Article Abstract:

Down's syndrome is an inherited disease caused by the presence of an extra chromosome 21. This disorder causes mental retardation, short stature, bowel defects, and heart abnormalities. Patients with Down's syndrome are extremely susceptible to respiratory infections. Several studies have reported that Down's syndrome is associated with abnormalities of the upper airways that can cause upper airway obstruction (UAO) and reduce the ability to breathe during sleep. In severe cases, UAO can lead to pulmonary hypertension (high blood pressure in the lung blood vessels) and heart failure. In children, UAO can result in poor growth, difficulty sleeping, daytime drowsiness, and chronic upper respiratory problems. A study was performed to determine the prevalence of UAO in 32 children with Down's syndrome. The children were between the ages of 0.1 and 4.9 years. UAO was diagnosed based on overnight recordings of chest wall movements and sounds, the amount of oxygen in the blood (SaO2, arterial oxygen saturation), and symptoms of UAO reported by parents in a questionnaire. Children without Down's syndrome were included in the study for comparison. Thirty-one percent of the children with Down's syndrome were diagnosed as having UAO. These children were more likely to have stridor (whistling-like noises during breathing) and low SaO2 than the children who did not have Down's syndrome. There was no difference in the incidence of excessive sweating, restlessness or breathing through the mouth between the children with and without Down's syndrome. The results of this study indicate that UAO is a common problem in children with Down's syndrome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Complications and side effects, Lung diseases, Obstructive, Chronic obstructive lung disease, Down syndrome

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