Published online December 1, 2008
PEDIATRICS Vol. 122 No. 6 December 2008, pp. e1242-e1248 (doi:10.1542/peds.2008-1400)
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ARTICLE

Blood Pressure and Heart Rate Patterns During Sleep Are Altered in Preterm-Born Infants: Implications for Sudden Infant Death Syndrome

Nicole B. Witcombe, BSc, Stephanie R. Yiallourou, PhD, Adrian M. Walker, PhD and Rosemary S.C. Horne, PhD

Ritchie Centre for Baby Health Research, Monash Institute of Medical Research, Monash University, Melbourne, Victoria, Australia

OBJECTIVE. Preterm infants are at an increased risk of sudden infant death syndrome, which may result from immature autonomic control of heart rate and blood pressure. Previous studies have demonstrated that preterm infants have altered heart rate and blood pressure control at term-equivalent age; however, little information is available beyond this age. The aim of this study was to determine the effect of preterm birth on heart rate and blood pressure control over the first 6 months of life after reaching term-equivalent age, including the age at which sudden infant death syndrome risk is increased, to understand the pathogenesis of sudden infant death syndrome.

METHODS. Preterm (n = 25) and term (n = 20) infants were studied longitudinally at 2 to 4 weeks', 2 to 3 months', and 5 to 6 months' term-corrected age by using daytime polysomnography. A photoplethysmographic cuff (Finometer) around the infant's wrist measured blood pressure during quiet and active sleep.

RESULTS. Blood pressure was lower in the preterm group during both quiet and active sleep at all ages studied. In contrast, there were no differences between groups in heart rate. Within the infants in the preterm group, blood pressure averaged lower at 2 to 3 months' corrected age compared with both 2 to 4 weeks' and 5 to 6 months' corrected age and was lower in quiet sleep compared with active sleep at all ages studied. Heart rate decreased with increasing age and was lower in quiet sleep compared with active sleep at 5 to 6 months' corrected age.

CONCLUSIONS. Sleep state and age affect heart rate and blood pressure patterns in prematurely born infants over the first 6 months of term-corrected age. It is notable that preterm infants had persistently lower blood pressure compared with age-matched term infants, signifying long-term alterations in cardiovascular control in infants born prematurely.

Key Words: sudden infant death syndrome • sleep • preterm infant • heart rate • blood pressure

Abbreviations: SIDS—sudden infant death syndrome • HR—heart rate • BP—blood pressure • CA—term-corrected age • GA—gestational age • SpO2—arterial blood oxygen saturation • QS—quiet sleep • AS—active sleep • MAP—mean arterial pressure • SAP—systolic arterial pressure • DAP—diastolic arterial pressure

Accepted Aug 31, 2008.


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