The transition from fetus to newborn is the most complex adaptation that occurs in human experience. Lung adaptation requires coordinated clearance of fetal lung fluid, surfactant secretion, and onset of consistent breathing. The cardiovascular response requires striking changes in blood flow, pressures, and pulmonary vasodilation. Energy metabolism and thermoregulation must be quickly controlled. The primary mediators that prepare the fetus for birth and support the multiorgan transition are cortisol and catecholamine. Abnormalities in adaptation are frequently found following preterm birth or cesarean delivery at term, and many of these infants need delivery room resuscitation to assist in this transition.
"Altogether these factors will predispose preterm infants to respiratory insufficiency and the need for positive pressure ventilation and oxygen supplementation. In this scenario, the achievement of a stable pre-ductal SpO 2 is substantially delayed even in healthy well-adapted preterm infants  . Recently, a group of researchers developed a SpO 2 reference range for the first ten minutes after birth for term and preterm infants who did not receive any medical intervention in the delivery room. "
[Show abstract][Hide abstract] ABSTRACT: CA and periodic breathing are common in infants, and are much more common in preterm than in term infants. The irregular breathing is seen in both active and quiet sleep. Irregular breathing tends to improve with increasing GA, and is presumed to be due to maturity of the respiratory control centers and chest-wall mechanics. Inlaboratory polysomnography is the study of choice for the evaluation of CA in infants. Most therapies directed at the treatment of CA are aimed at stabilizing the breathing pattern and preventing oxygen desaturation. Most of these therapies are temporary, and are used for a brief period in preterm and term infants until the breathing matures.
Sleep Medicine Clinics 01/2013; 9(1). DOI:10.1016/j.jsmc.2013.10.009
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