19. SIDS

Question 1

what is apnea of prematurity?

Answer 1

periodic breathing (which is an oscillatory breathing pattern), and also respiratory pauses (apnea)

Question 2

prematures spend more time in what types of resp patterns?

Answer 2

periodic, apneic, irregular

Question 3

what do apnea and periodic breathing cause that is problematic?

Answer 3

decr in HR, oxygenation

Question 4

in neonates, why does hypoxia depress rather than stimulate both breathing and HR?

Answer 4

neonates are very prone to CNS depression, and if hypoxia is sufficient it will depress both RR and HR.

Question 5

which is more impt in a neonate, 02 desat or bradycardia?

Answer 5

neither is very good, but bradycardia may be more of a problem

Question 6

what is the adult ventilatory response to C02?

Answer 6

very sensitive to rising C02 levels, very linear response.
little change -> little response.
big change -> big response.
response reduced when asleep

Question 7

what is the neonate response to C02?

Answer 7

very insensitive but still linear.
-big change in C02 -> little response.
increaseing sensitivity to C02 is part of development.

Question 8

in the adult, what is the deal with the central pattern generator?

Answer 8

impressive connectivity, impressive redundancy, much internally generated neuronal cross talk (feedback).

Question 9

in neonates, what is the deal with the central pattern generator?

Answer 9

much less connectivity, much less redundancy, less internal feedback so rhythmic stability is much more dependent on external stimuli

Question 10

what happens to neonates if one or more of the factors driving ventilation is reduced? (ventilation, sleep, 02)

Answer 10

if one or more inputs is interrupted, cannot maintain resp stability.

Question 11

what is the problem with neonates and sleep, in regards to breathing?

Answer 11

sleep dulls external inputs, so since neonates rely heavily on that for breathing, sleep increases resp instability.

Question 12

what is the ventilatory response to hypoxia in adults?

Answer 12

not very sensitive, definitely not linear. have to get very low on 02 before response kicks in.

Question 13

what is the ventilatory response to hypoxia in neonates?

Answer 13

same as adults (not sens, nonlinear). especially weak if PaC02 is also low. especially weak in prematures.

Question 14

what is the biphasic ventilatory response to hypoxia? is it stronger in neonats or adults?

Answer 14

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.

Question 15

how does having small lungs/small FRC affect the rapidity of changes to 02 and C02?

Answer 15

smaller lungs/smaller FRC = unstable, means larger gas changes.

Question 16

how does having bigger lungs/bigger FRC affect rate of change of C02 and 02?

Answer 16

more of a reserve/reservoir than small lungs/small FRC. smaller rate of change, reduced amplitude of gas changes.

Question 17

what is the difference between a baby airway and an adult airway?

Answer 17

baby airway = soft, prone to collapse. remember Bernoulli’s.

Question 18

what are the factors that contribute to oscillatory breathing patterns and apnea in premature infants?

Answer 18

immature wiring
decr responsiveness to C02
biphasic ventilatory response to C02
low FRC
easily collapsable upper airway
unstable system (small system, no reservoir of stability)

Question 19

how would you treat infant apnea?

Answer 19

CPAP, add C02 to inspired gas, tactile stimulation (waterbed!), caffeine

Question 20

what is SUID? what is SIDS?

Answer 20

Sudden Unexpected Infant Death

Sudden Infant Death Sx (a SUID that remains unexplained)

Question 21

what is asphyxia?

Answer 21

any situation in whcih there is a decr in 02 and an increase in C02 in the body.

Question 22

what are 3 forms of asphyxia?

Answer 22

suffocation
entrapment
strangulation

Question 23

what needs to be in place for SIDS to occur?

Answer 23

environmental cause and also baby that is vulnerable AND being in a critical developmental period (6 mo)

Question 24

what has been found in a majority of SIDS infants?

Answer 24

brainstem abnormalities - decreased receptor binding, decreased levels of serotonin, etc etc

Question 25

what is recommended to prevent SIDS, suffocation, entrapment, other accidental deaths?

Answer 25

safe sleep:
back to sleep
firm sleep surface
no soft objects, no blankets
avoid smoke exposure