Neuropediatrics 2000; 31(2): 82-85
DOI: 10.1055/s-2000-7477
Original Article

Georg Thieme Verlag Stuttgart · New York

Changes in Cerebral Blood Volume and Cerebral Oxygenation during Periodic Breathing in Term Infants

B. Urlesberger, G. Pichler, Eva Gradnitzer, F. Reiterer, G. Zobel, W. Müller
  • Division of Neonatology, Department of Paediatrics, University of Graz, Austria
Further Information

Publication History

Publication Date:
31 December 2000 (online)

The present study is an analysis of changes in cerebral oxygenation and cerebral blood volume (CBV) during periodic breathing in healthy term infants by means of near infrared spectroscopy (NIRS). Polygraphy included electrocardiogram, electrooculogram, heart rate, oxygen saturation, side stream capnography, two respiratory effort sensors, a movement sensor, and NIRS. During periodic breathing analysis of behaviour of total haemoglobin (cHbtot), ΔCBV, the haemoglobin oxygenation index (cHbD), and cytochrome oxidase (CytOx) was performed.

In ten healthy term infants 30 cycles of periodic breathing with a mean of 10 apnoeas per cycle were analysed. Corresponding cyclical variations of cHbD appeared in 98 %, cyclical variations of cHbtot appeared in 42 % of all apnoeas. During phases of apnoea, a mean decrease of cHbD of - 3.45 µmol/l occurred 1.75 seconds after onset of apnoea, and a mean decrease of cHbtot of - 0.79 µmol / occurred 0.74 seconds after onset of apnoea. During these apnoeas, the ΔCBV was - 44 µl/100 g brain. During phases of ventilation, there was an increase of cHbD and cHbtot to the pre-apnoeic levels. There was a tendency that CytOx values decreased during periodic breathing, the amount of decrease was - 0.32 µmol/l.

In conclusion, the present study was able to show for the first time that there is cyclical desaturation and reoxygenation of cerebral blood during periodic breathing. Cyclical changes in CBV in association with periodic apnoea occurred only in 42 % of apnoea.

References

  • 1 Barrington K J, Finer N N, Wilkinson M H. Progressive shortening of the periodic breathing cycle duration in normal infants.  Pediatr Res. 1987;  21 247-251
  • 2 Belenky D A, Standaert T A, Woodrum D E. Maturation of hypoxic ventilatory response of the newborn lamb.  J Appl Physiol. 1979;  47 927-930
  • 3 Bhutani V K, Sivieri E M, Abbasi S. Evaluation of pulmonary function in the neonate. Polin RA, Fox WW Fetal and Neonatal Physiology. Philadelphia; WB Saunders 1998: 1143-1164
  • 4 Bucher H U, Wolf M, Keel M, von Siebenthal K, Duc G. Effect of aminophylline on cerebral haemodynamics and oxidative metabolism in premature infants.  Eur J Pediatr. 1994;  153 123-128
  • 5 Cooper C E, Delpy D T, Nemeto E M. The relationship of oxygen delivery to absolute haemoglobin oxygenation and mitochondrial cytochrome oxidase redox state in the adult brain: a near infrared spectroscopy study.  Biochem J. 1998;  332 627-632
  • 6 Edwards A D, Brown G C, Cope M, Wyatt J S, McCormick D C, Roth S, Delpy D, Reynolds E OR. Quantification of concentration changes in neonatal human cerebral oxidized cytochrome oxidase.  J Appl Physiol. 1991;  71 1907-1913
  • 7 Findley L J, Ries A L, Tisi G M, Wagner P D. Hypoxemia during apnea in normal subjects: mechanisms and impact of lung volume.  J Appl Physiol. 1986;  55 1777-1783
  • 8 Glotzbach S F, Baldwin R B, Lederer N E, Tansey P A, Ariagno R L. Periodic breathing in preterm infants: Incidence and characteristics.  Pediatr. 1989;  84 785-792
  • 9 Henderson-Smart D J. Vulnerability to hypoxemia in the newborn.  Sleep. 1980;  3 331-342
  • 10 Jenni O G, Bucher H U, von Siebenthal K, Wolf M, Keel M, Duc G. Cyclical variations in cerebral blood volume during periodic breathing.  Acta Pediatr. 1994;  83 1095-1096
  • 11 Jenni O G, Wolf M, Hengartner M, von Siebenthal K, Keel M, Bucher H U. Impact of central, obstructive and mixed apnea on cerebral haemodynamics in preterm infants.  Biol Neonate. 1996;  70 91-100
  • 12 Jöbsis F F. Non-invasive infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters.  Science. 1977;  198 1264-1266
  • 13 Khoo M CK, Kronauer K P, Strohl K P, Slutsky A S. Factors inducing periodic breathing in humans: a general model.  J Appl Physiol. 1982;  53 644-659
  • 14 Lahiri S, Maret K, Sherpa M G. Dependence of high altitude sleep apnoea on ventilatory sensitivity to hypoxia.  Respir Physiol. 1983;  52 281-301
  • 15 McCormick D C, Edwards A D, Brown B C, Wyatt J S, Potter A, Cope M, Delpy D T, Reynolds E OR. Effect of Indomethacin on cerebral oxidized cytochrome oxidase in preterm infants.  Pediatr Res. 1993;  33 603-608
  • 16 Perlman J M, Volpe J J. Episodes of apnea and bradycardia in the preterm newborn: Impact on cerebral circulation.  Pediatr. 1985;  76 333-338
  • 17 Poets C F, Southall D P. Patterns of oxygenation during periodic breathing in preterm infants.  Early Hum Dev. 1991;  26 1-12
  • 18 Poets C F, Samuels M P, Southall D P. Potential role of intrapulmonary shunting in the genesis of hypoxemic episodes in infants and young children.  Pediatr. 1992;  90 385-391
  • 19 Rigatto H, Brady J. Periodic breathing and apnea in preterm infants. I. Evidence for hypoventilation possibly due to central respiratory depression.  Pediatrics. 1972;  50 202-218
  • 20 Rigatto H, Brady J. Periodic breathing and apnea in preterm infants. II. Hypoxia as a primary event.  Pediatrics. 1972;  50 219-228
  • 21 Shannon D C, Carley D W, Kelly D H. Periodic breathing: Quantitative analysis and clinical description.  Pediatr Pulmonol. 1988;  4 98-102
  • 22 Strohl K P, Altose D A. Oxygen saturation during breath-holding and during apneas in sleep.  Chest. 1994;  85 181-186
  • 23 Urlesberger B, Trip K, Ruchti J JI, Kerbl R, Reiterer F, Müller W. Quantification of cyclical fluctuations in cerebral blood volume in healthy infants.  Neuropediatrics. 1998;  29 208-211
  • 24 Urlesberger B, Kaspirek A, Pichler G, Müller W. Apnoea of prematurity and changes in cerebral oxygenation and cerebral blood volume.  Neuropediatrics. 1999;  30 29-33
  • 25 Wilkinson M H, Berger P J, Blanch N, Brodecky V. Effect of venous oxygenation on arterial desaturation rate during repetitive apneas in lambs.  Respir Physiol. 1995;  101 321-331
  • 26 Wilkinson M H, Cranage S, Berger P J, Blanch N, Adamson T M. Changes in temporal structure of periodic breathing with postnatal development in preterm infants.  Pediatr Res. 1995;  38 533-538
  • 27 Wilkinson M H, Berger P J, Blanch N, Brodecky V, Jones C. Source of respiratory drive during periodic breathing in lambs.  Respir Physiol. 1996;  104 115-126
  • 28 Wyatt J S, Cope M, Delpy D T, Wray S, Reynolds E OR. Quantification of cerebral oxygenation and haemodynamics in sick newborn infants by near infrared spectrophotometry.  Lancet. 1986;  II 1063-1066
  • 29 Wyatt J S, Edwards A D, Cope M. et al . Response of cerebral blood volume to changes in arterial carbon dioxide tension in preterm and term infants.  Pediatr Res. 1991;  29 533-537
  • 30 Wyatt J S, Cope M, Delpy D T. et al . Quantitation of cerebral blood volume in newborn infants by near infrared spectroscopy.  J Appl Physiol. 1991;  68 1086-1091
  • 31 van der Zee P, Cope M, Arridge S R. et al . Experimentally measured optical pathlengths for adult head, calf and forearm and the head of the newborn infant as a function of inter optode spacing.  Adv Exp Med Biol. 1991;  316 143-144

M. D. Berndt Urlesberger

Abt. für Neonatologie Universitätsklinik für Kinder- und Jugendheilkunde

Auenbruggerplatz 30

8036 Graz

Austria

Email: E-mail: berndt.urlesberger@kfunigraz.ac.at