Respiratory inhibition after crying in infants.
BACKGROUND
Among full-term neonates, the authors discovered infants who showed respiratory inhibition after crying which involved a marked decrease in SpO2. The infants were found to present increased echogenicity or a cyst in a cranial region termed the ganglionic eminence, or to have a subependymal cyst. The authors prospectively examined the relationship between respiratory inhibition after crying and these changes to examine the prevention and treatment of the episode.


METHODS
The authors conducted cranial ultrasonography to screen 381 full-term neonates who showed no abnormalities at birth and whose parents requested ultrasonographic screening of the head, followed by polygraphy of infants who showed increased echogenicity or a cyst in ganglionic eminence, or had a subependymal cyst. The authors similarly conducted polygraphy for 50 neonates without cranial ultrasound abnormalities; the former constituted the control group. Respiratory inhibition was defined to be central apnea immediately after crying with a decrease in SpO2 to <60%.


RESULTS
Among 381 neonates examined, 104 showed cranial ultrasound abnormalities; 60 of the 104 neonates indicated respiratory inhibition after crying. Oxygenation failed to improve the episode in 17 neonates with severe respiratory inhibition. However, theophylline alleviated the episode, and SpO2 no longer decreased to <60%. Theophylline was discontinued successfully by 6 months after birth, while 50 neonates in the control group showed no respiratory inhibition after crying.


CONCLUSIONS
Respiratory inhibition after crying which involved a marked decrease in SpO2 was observed in full-term neonates who showed no abnormalities after birth. These neonates could be screened by cranial ultrasonography.
Minowa
Hideki
H
Division of Pediatrics, Nara Hospital, Kinki University School of Medicine, Ikoma, Nara, Japan. nicu@m3.kcn.ne.jp
Kubo
Satomi
S
Yoshizawa
Hiroyuki
H
Hayashi
Yukiko
Y
Hayashi
Tamaki
T
Yoshida
Koichi
K
Ebisu
Reiko
R
Uchida
Yumiko
Y
Ohgitani
Ayako
A
D001049:Apnea / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001927:Brain Diseases / Q000000981:diagnostic imaging; D001993:Bronchodilator Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D003448:Crying; D003560:Cysts / Q000000981:diagnostic imaging; D005260:Female; D006257:Head / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening; D010092:Oximetry / Q000379:methods; D010100:Oxygen / Q000097:blood; D017286:Polysomnography; D011379:Prognosis; D011446:Prospective Studies; D012119:Respiration; D013806:Theophylline / Q000627:therapeutic use; D016896:Treatment Outcome; D014463:Ultrasonography
D001993:Bronchodilator Agents; D013806:Theophylline; D010100:Oxygen