Neonatal Apnoea and SIDS Flashcards Preview

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Flashcards in Neonatal Apnoea and SIDS Deck (12)
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1

What factors influence breathing?

Influences from higher centres
Arterial and central chemoreceptors
Lung, airway, CV, muscle and joint reflexes

2

Where is the respiratory pattern generator?

Reticular formation of the medulla

Pre-Botzinger Complex

3

Define apnoea

20seconds or less if associated with cyanosis or bradycardia

Inverse correlation between freq apnoea and gestational age

4

What are the 3 types of apnoea?

1 - central
2 - obstructive = breathing effort continues but with no airflow
3 - mixed

5

What is the mechanism of central apnoea?

Immaturity in the chemoreceptor, mechanoreceptor or cerebral cortex pathway which feed in to the pre-Botzinger complex

Chemoreceptors show a reduced response in infants.

Mechanoreceptors (HB Reflex) depressed in prematurity

6

What is obstructive apnoea?

Site tends to be at laryngeal level as shown by bronchoscopy

? due to hypoxia or asynchrony of respiratory muscles (alae nasi and diaphragm)

7

Factors involved in apnoea?

Sleep state (> REM)
Hypoxia
Infection
CNS disorders
Environmental temp
GORD
Bottle feeding
Anaemia
Anaesthesia
PDA
Drugs

8

Rx of apnoea?

Methylxanthines

Compete with adenosine? Reduce release of GABA

Kinasthetic stimulation
Tilt
Position change
Change environmental temperature
Correct hypoxia

9

Do apnoeas matter?

Recurrent hypoxaemia
Redistribution of blood away from guts and kidney
Fall in anterior cerebral blood flow velocities during the apnoea

10

What is SIDS?

The sudden death of an infant under one year of age which remains unexplained after a thorough case investigation including a complete autopsy, examination of death scene and review of clinical history.

11

Risk factors for SIDS

Maternal smoking
Prone and side sleeping
Soft bedding and soft surfaces
Warmer room temps
Bed sharing
Prematurity

12

Which areas of brain may be involved?

Arcuate nucleus - hypoplasia common, hypoplasia correlated with maternal smoking, 5-HT system and glutamate abnormalities records in AN (also systemic)

Cerebellum - abnormalities in SIDS victims, delayed maturation in SIDS, biopathological alterations in smoking mothers, prone to nicotine damage, ? effect of position on BP?