PEDIATRICS Vol. 72 No. 4 October 1983, pp. 541-551
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Undetected Episodes of Prolonged Apnea and Severe Bradycardia in Preterm Infants

D. P. Southall MD, MRCP1, G. A. Levitt BSc, MRCP1, J. M. Richards BSc1, R. A. K. Jones MD, MRCP1, C. Kong BSc1, P. A. Farndon MB, MRCP, DCH1, J. R. Alexander MSc, FSS1, and A. J. Wilson Phd1

1 From the Department of Paediatrics, Cardiothoracic Institute, Department of Paediatrics, Queen Charlotte's Hospital, Department of Paediatrics and Neonatal Medicine, Hammersmith Hospital, Department of Statistics and Computer Science, Thames Polytechnic, London; Department of Child Health, Southampton General Hospital, Southampton, and Department of Medical Physics, Royal Hallamshire Hospital, Sheffield, England

Twenty-four-hour tape recordings of ECG and breathing movement were made on 14 preterm infants with prolonged apneic episodes. Despite apnea monitoring systems, 136/203 (67%) apneic episodes ge20 seconds in duration, including 19 episodes ge50 seconds in duration, were not recorded by nursing staff. Of 120 apneic episodes ge30 seconds, 100 (89%) were accompanied by bradycardia le100 beats per minute. Episodes of more marked bradycardia (le80 beats per minute and up to seven minutes in duration) occurred without cessation of breathing movement in 10/14 infants studied. Treatment with theophylline or aminophylline was associated with a reduction in the number of episodes of apnea ge20 seconds accompanied by bradycardia le80 beats per minute (P < .001). Many prolonged episodes of apnea and bradycardia are going unnoticed in neonatal intensive care units. Further studies are required to investigate and overcome the causes of these failures.

Key Words: apnea • bradycardia • preterm infants • xanthines

Submitted on January 25, 1983
Accepted on May 11, 1983




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