title: Clinical associations with immature breathing in preterm infants: part 2-periodic breathing.
abstract: Periodic breathing (PB) is a normal immature breathing pattern in neonates that, if extreme, may be associated with pathologic conditions.
  
  
  
  We used our automated PB detection system to analyze all bedside monitor chest impedance data on all infants <35 wk' gestation in the University of Virginia Neonatal Intensive Care Unit from 2009-2014 (n = 1,211). Percent time spent in PB was calculated hourly (>50 infant-years' data). Extreme PB was identified as a 12-h period with PB >6 SDs above the mean for gestational age (GA) and postmenstrual age and >10% time in PB.
  
  
  
  PB increased with GA, with the highest amount in infants 30-33 wk' GA at about 2 wk' chronologic age. Extreme PB was identified in 76 infants and in 45% was temporally associated with clinical events including infection or necrotizing enterocolitis (NEC), immunizations, or caffeine discontinuation. In 8 out of 28 cases of septicemia and 10 out of 21 cases of NEC, there was a >2-fold increase in %PB over baseline on the day prior to diagnosis.
  
  
  
  Infants <35 wk GA spend, on average, <6% of the time in PB. An acute increase in PB may reflect illness or physiological stressors or may occur without any apparent clinical event.
authors.affiliation: Department of Pediatrics, The University of Virginia School of Medicine, Charlottesville, Virginia, USA.
authors.forename: Manisha
authors.initials: M
authors.lastname: Patel
authors.affiliation: Department of Physics, The College of William and Mary, Williamsburg, Virginia, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Mohr
authors.affiliation: Department of Medicine, The University of Virginia School of Medicine, Charlottesville, Virginia, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Lake
authors.affiliation: Department of Physics, The College of William and Mary, Williamsburg, Virginia, USA.
authors.forename: John
authors.initials: J
authors.lastname: Delos
authors.affiliation: Department of Medicine, The University of Virginia School of Medicine, Charlottesville, Virginia, USA.
authors.forename: J Randall
authors.initials: JR
authors.lastname: Moorman
authors.affiliation: Department of Pediatrics, The University of Virginia School of Medicine, Charlottesville, Virginia, USA.
authors.forename: Robert A
authors.identifier: 0000-0002-3580-0329
authors.initials: RA
authors.lastname: Sinkin
authors.affiliation: Department of Pediatrics, The University of Virginia School of Medicine, Charlottesville, Virginia, USA.
authors.forename: John
authors.initials: J
authors.lastname: Kattwinkel
authors.affiliation: Department of Pediatrics, The University of Virginia School of Medicine, Charlottesville, Virginia, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Fairchild
mesh_terms: D002110:Caffeine / Q000627:therapeutic use; D015331:Cohort Studies; D017097:Electric Impedance; D020345:Enterocolitis, Necrotizing / Q000150:complications; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal; D008297:Male; D008991:Monitoring, Physiologic; D012119:Respiration; D012120:Respiration Disorders / Q000150:complications* / Q000503:physiopathology*; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000150:complications; D013997:Time Factors
chemical_list: D002110:Caffeine