Neuromodulation of Limb Proprioceptive Afferents Decreases Apnea of Prematurity and Accompanying Intermittent Hypoxia and Bradycardia.
BACKGROUND
Apnea of Prematurity (AOP) is common, affecting the majority of infants born at <34 weeks gestational age. Apnea and periodic breathing are accompanied by intermittent hypoxia (IH). Animal and human studies demonstrate that IH exposure contributes to multiple pathologies, including retinopathy of prematurity (ROP), injury to sympathetic ganglia regulating cardiovascular action, impaired pancreatic islet cell and bone development, cerebellar injury, and neurodevelopmental disabilities. Current standard of care for AOP/IH includes prone positioning, positive pressure ventilation, and methylxanthine therapy; these interventions are inadequate, and not optimal for early development.


OBJECTIVE
The objective is to support breathing in premature infants by using a simple, non-invasive vibratory device placed over limb proprioceptor fibers, an intervention using the principle that limb movements trigger reflexive facilitation of breathing.


METHODS
Premature infants (23-34 wks gestational age), with clinical evidence of AOP/IH episodes were enrolled 1 week after birth. Caffeine treatment was not a reason for exclusion. Small vibration devices were placed on one hand and one foot and activated in 6 hour ON/OFF sequences for a total of 24 hours. Heart rate, respiratory rate, oxygen saturation (SpO2), and breathing pauses were continuously collected.


RESULTS
Fewer respiratory pauses occurred during vibration periods, relative to baseline (p<0.005). Significantly fewer SpO2 declines occurred with vibration (p<0.05), relative to control periods. Significantly fewer bradycardic events occurred during vibration periods, relative to no vibration periods (p<0.05).


CONCLUSIONS
In premature neonates, limb proprioceptive stimulation, simulating limb movement, reduces breathing pauses and IH episodes, and lowers the number of bradycardic events that accompany aberrant breathing episodes. This low-cost neuromodulatory procedure has the potential to provide a non-invasive intervention to reduce apnea, bradycardia and intermittent hypoxia in premature neonates.


BACKGROUND
ClinicalTrials.gov NCT02641249.
Pediatrics, University of California Los Angeles, Los Angeles, California, United States of America.
Kalpashri
K
Kesavan
Cardiothoracic Surgery, University of California Los Angeles, Los Angeles, California, United States of America.
Paul
P
Frank
Pediatrics, University of California Los Angeles, Los Angeles, California, United States of America.
Daniella M
DM
Cordero
Surgery, Harbor-UCLA, Los Angeles, California, United States of America.
Peyman
P
Benharash
Neurobiology, University of California Los Angeles, Los Angeles, California, United States of America.
Ronald M
RM
Harper
D000344:Afferent Pathways / Q000502:physiology; D001049:Apnea / Q000503:physiopathology / Q000628:therapy*; D001724:Birth Weight; D001919:Bradycardia / Q000503:physiopathology / Q000628:therapy*; D005121:Extremities / Q000294:innervation; D005260:Female; D005865:Gestational Age; D006801:Humans; D000860:Hypoxia / Q000503:physiopathology / Q000628:therapy*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000503:physiopathology / Q000628:therapy*; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods*; D008297:Male; D010865:Pilot Projects; D011434:Proprioception / Q000502:physiology; D012119:Respiration; D016896:Treatment Outcome