Flashcards in 19. SIDS Deck (25):
what is apnea of prematurity?
periodic breathing (which is an oscillatory breathing pattern), and also respiratory pauses (apnea)
prematures spend more time in what types of resp patterns?
periodic, apneic, irregular
what do apnea and periodic breathing cause that is problematic?
decr in HR, oxygenation
in neonates, why does hypoxia depress rather than stimulate both breathing and HR?
neonates are very prone to CNS depression, and if hypoxia is sufficient it will depress both RR and HR.
which is more impt in a neonate, 02 desat or bradycardia?
neither is very good, but bradycardia may be more of a problem
what is the adult ventilatory response to C02?
very sensitive to rising C02 levels, very linear response.
little change -> little response.
big change -> big response.
response reduced when asleep
what is the neonate response to C02?
very insensitive but still linear.
-big change in C02 -> little response.
increaseing sensitivity to C02 is part of development.
in the adult, what is the deal with the central pattern generator?
impressive connectivity, impressive redundancy, much internally generated neuronal cross talk (feedback).
in neonates, what is the deal with the central pattern generator?
much less connectivity, much less redundancy, less internal feedback so rhythmic stability is much more dependent on external stimuli
what happens to neonates if one or more of the factors driving ventilation is reduced? (ventilation, sleep, 02)
if one or more inputs is interrupted, cannot maintain resp stability.
what is the problem with neonates and sleep, in regards to breathing?
sleep dulls external inputs, so since neonates rely heavily on that for breathing, sleep increases resp instability.
what is the ventilatory response to hypoxia in adults?
not very sensitive, definitely not linear. have to get very low on 02 before response kicks in.
what is the ventilatory response to hypoxia in neonates?
same as adults (not sens, nonlinear). especially weak if PaC02 is also low. especially weak in prematures.
what is the biphasic ventilatory response to hypoxia? is it stronger in neonats or adults?
over time (min), response to hypoxia is to inc minute ventilation briefly and then rapidly decr minute ventilation. younger babies will have more severe decrease than adults.
how does having small lungs/small FRC affect the rapidity of changes to 02 and C02?
smaller lungs/smaller FRC = unstable, means larger gas changes.
how does having bigger lungs/bigger FRC affect rate of change of C02 and 02?
more of a reserve/reservoir than small lungs/small FRC. smaller rate of change, reduced amplitude of gas changes.
what is the difference between a baby airway and an adult airway?
baby airway = soft, prone to collapse. remember Bernoulli's.
what are the factors that contribute to oscillatory breathing patterns and apnea in premature infants?
decr responsiveness to C02
biphasic ventilatory response to C02
easily collapsable upper airway
unstable system (small system, no reservoir of stability)
how would you treat infant apnea?
CPAP, add C02 to inspired gas, tactile stimulation (waterbed!), caffeine
what is SUID? what is SIDS?
Sudden Unexpected Infant Death
Sudden Infant Death Sx (a SUID that remains unexplained)
what is asphyxia?
any situation in whcih there is a decr in 02 and an increase in C02 in the body.
what are 3 forms of asphyxia?
what needs to be in place for SIDS to occur?
environmental cause and also baby that is vulnerable AND being in a critical developmental period (6 mo)
what has been found in a majority of SIDS infants?
brainstem abnormalities - decreased receptor binding, decreased levels of serotonin, etc etc