Tachycardia–Desaturation Episodes in Neonatal Intensive Care Unit Patients with and without Bronchopulmonary Dysplasia

Abstract

Objectives

Much attention has been paid to measuring physiological episodes of bradycardia–oxygen desaturation (BDs) in the neonatal intensive care unit (NICU). NICU patients also have spells of tachycardia–desaturation (TDs), but these have not been well-characterized. We hypothesized that TDs would be more common among infants with bronchopulmonary dysplasia (BPD). We aimed to quantify daily TDs compared to BDs in NICU patients across a range of gestational and postmenstrual ages (GA and PMA) and determine whether TDs are associated with BPD.

Study Design

We analyzed every 2-second heart rate (HR) and peripheral saturation of oxygen (SpO₂) throughout the NICU stay of all infants with 24 to 39 weeks GA admitted to a single, level IV NICU from 2012 to 2015. BDs were defined in our prior work (HR <100 bpm for ≥4 seconds with concurrent SpO₂ <80% for ≥10 seconds) and TDs as a 20% increase in HR from the previous 2-hour mean baseline and concurrent SpO₂ <80% for ≥10 seconds. We calculated the median daily BDs and TDs across a range of GAs and PMAs. For infants ≤32 weeks GA, we compared TDs for those with and without BPD at 36 weeks PMA and discharge on supplemental oxygen.

Results

We analyzed 782,424 hours of HR and SpO₂ data from 1,718 neonates, with a median of 271 hours analyzed per infant. TDs frequency increased with increasing PMA across all GAs. BDs occurred most frequently in infants <29 weeks GA and decreased as infants approached term equivalent age. For infants with ≤32 weeks GA, one or more TD per day from 33 to 35 weeks PMA was associated with BPD and home oxygen.

Conclusion

Episodes of TD at the thresholds defined in this analysis occurred more frequently at later PMA and were more common in infants with BPD and those requiring home oxygen.

Key Points

• Desaturation episodes occur often in preterm infants.

• Bradycardia or tachycardia can coincide with desaturation.

• TD occurs later and with BPD.

Keywords

neonates - desaturation - tachycardia - bronchopulmonary dysplasia

Ethical Approval

This study was conducted in accordance with the principles embodied in the Declaration of Helsinki and in accordance with local statutory requirements. The University of Virginia Institutional Review Board approved this study with a waiver of informed consent (protocol #HSR 12008).

Publikationsverlauf

Eingereicht: 02. Juli 2024

Angenommen: 08. Oktober 2024

Accepted Manuscript online:
09. Oktober 2024

Artikel online veröffentlicht:
19. November 2024

• References

• 1 Fairchild K, Mohr M, Paget-Brown A. et al. Clinical associations of immature breathing in preterm infants: part 1-central apnea. Pediatr Res 2016; 80 (01) 21-27
• 2 Di Fiore JM, Martin RJ, Li H. et al; SUPPORT Study Group of the Eunice Kennedy Shriver National Institute of Child Health, and Human Development Neonatal Research Network. Patterns of oxygenation, mortality, and growth status in the surfactant positive pressure and oxygen trial cohort. J Pediatr 2017; 186: 49-56.e1
• 3 Ambalavanan N, Weese-Mayer DE, Hibbs AM. et al; Prematurity-related Ventilatory Control (Pre-Vent) Investigators. Cardiorespiratory monitoring data to predict respiratory outcomes in extremely preterm infants. Am J Respir Crit Care Med 2023; 208 (01) 79-97
• 4 Nagraj VP, Sinkin RA, Lake DE, Moorman JR, Fairchild KD. Recovery from bradycardia and desaturation events at 32 weeks corrected age and NICU length of stay: an indicator of physiologic resilience?. Pediatr Res 2019; 86 (05) 622-627
• 5 Poets CF, Roberts RS, Schmidt B. et al; Canadian Oxygen Trial Investigators. Association between intermittent hypoxemia or bradycardia and late death or disability in extremely preterm infants. JAMA 2015; 314 (06) 595-603
• 6 Raffay TM, Dylag AM, Sattar A. et al. Neonatal intermittent hypoxemia events are associated with diagnosis of bronchopulmonary dysplasia at 36 weeks postmenstrual age. Pediatr Res 2019; 85 (03) 318-323
• 7 Nagraj VP, Lake DE, Kuhn L, Moorman JR, Fairchild KD. Central apnea of prematurity: does sex matter?. Am J Perinatol 2021; 38 (13) 1428-1434
• 8 Fairchild KD, Nagraj VP, Sullivan BA, Moorman JR, Lake DE. Oxygen desaturations in the early neonatal period predict development of bronchopulmonary dysplasia. Pediatr Res 2019; 85 (07) 987-993
• 9 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
• 10 Poindexter BB, Feng R, Schmidt B. et al; Prematurity and Respiratory Outcomes Program. Comparisons and limitations of current definitions of bronchopulmonary dysplasia for the prematurity and respiratory outcomes program. Ann Am Thorac Soc 2015; 12 (12) 1822-1830
• 11 Finer NN, Barrington KJ, Hayes BJ, Hugh A. Obstructive, mixed, and central apnea in the neonate: physiologic correlates. J Pediatr 1992; 121 (06) 943-950
• 12 Walter LM, Ooi JY, Kleeman EA, Bassam A, Nixon GM, Horne RS. Heart rate surge at respiratory event termination in preterm and term born children with sleep disordered breathing. Sleep Med 2023; 101: 127-134
• 13 Hoppenbrouwers T, Hodgman JE, Cabal L. Obstructive apnea, associated patterns of movement, heart rate, and oxygenation in infants at low and increased risk for SIDS. Pediatr Pulmonol 1993; 15 (01) 1-12
• 14 Allinson LG, Denehy L, Doyle LW. et al. Physiological stress responses in infants at 29-32 weeks' postmenstrual age during clustered nursing cares and standardised neurobehavioural assessments. BMJ Paediatr Open 2017; 1 (01) e000025
• 15 Dormishian A, Schott A, Aguilar AC. et al. Etiology and mechanism of intermittent hypoxemia episodes in spontaneously breathing extremely premature infants. J Pediatr 2023; 262: 113623
• 16 McClure C, Jang SY, Fairchild K. Alarms, oxygen saturations, and SpO2 averaging time in the NICU. J Neonatal Perinatal Med 2016; 9 (04) 357-362