The effect of a low continuous positive airway pressure on the reflex control of respiration in the preterm infant

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The airway occlusion technique was used to measure the strength of the Hering-Breuer inflation reflex before and during the administration of low pressure CPAP. In five of 12 preterm infants studied in the first two weeks of life, CPAP did not alter the inflation reflex. In the other seven premature infants, shortened rather than lengthened inspiratory efforts were observed on occlusion 32 times off CPAP but only twice on CPAP. In seven term infants at 1 to 2.5 hours of age this shortening was noted only twice in 58 occlusions. In the preterm infants exhibiting short responses, the peak inspiratory pressure generated in response to occlusion rose on CPAP from 3.4 to 7.1 cm H2O (p<0.005), while respiratory rate fell from 61 to 49 breaths/minute (p<0.025). This data suggests that CPAP enhances these infants' ability to adjust to increased respiratory loads, possibly by the elimination of a Hering-Breuer deflation reflex.

References (22)

  • KattwinkelJ et al.

    Apnea of prematurity

    J Pediatr

    (1975)
  • DubowitzLMS et al.

    Clinical assessment of gestational age in the newborn infant

    J Pediatr

    (1970)
  • WhitelawWA et al.

    Occlusion pressure as a measure of respiratory center output in conscious man

    Resp Physiol

    (1975)
  • DailyWJR et al.

    Apnea in premature infants: Monitoring, incidence and an effect of environmental temperature

    Pediatrics

    (1969)
  • RigattoH et al.

    Periodic breathing and apnea in preterm infants. II. Hypoxia as a primary event

    Pediatrics

    (1972)
  • CrossKW et al.

    The response of the newborn baby to inflation of the lungs

    J Physiol

    (1960)
  • GrunsteinMM et al.

    Control of tidal volume and respiratory frequency in anesthetized cats

    J Appl Physiol

    (1973)
  • OlinskyA et al.

    Influence of lung inflation on respiratory control in neonates

    J Appl Physiol

    (1974)
  • KattwinkelJ et al.

    A device for administration of continuous positive airway pressure by the nasal route

    Pediatrics

    (1973)
  • ParmeleeAH et al.

    Sleep states in premature infants

    Dev Med Child Neurol

    (1967)
  • KnillR et al.

    An intercostal-phrenic inhibitory reflex in human newborn infants

    Physiologist

    (1976)
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    Supported by the Educational Foundation of America and United States Public Health Service Grant nos. 5-M01-RR00210-12 and GM-01090.

    Presented in part at the annual meeting of the Society for Pediatric Research, St. Louis, Missouri, April 30, 1976

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