title: Antenatal smoking and substance-misuse, infant and newborn response to hypoxia.
abstract: OBJECTIVE
  To determine at the peak age for sudden infant death syndrome (SIDS) the ventilatory response to hypoxia of infants whose mothers substance misused in pregnancy (SM infants), or smoked during pregnancy (S mothers) and controls whose mothers neither substance misused or smoked. In addition, we compared the ventilatory response to hypoxia during the neonatal period and peak age of SIDS.
  
  
  OBJECTIVE
  Infants of S or SM mothers compared to control infants would have a poorer ventilatory response to hypoxia at the peak age of SIDS.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  Twelve S; 12 SM and 11 control infants were assessed at 6-12 weeks of age and in the neonatal period.
  
  
  METHODS
  Changes in minute volume, oxygen saturation, heart rate, and end tidal carbon dioxide levels on switching from breathing room air to 15% oxygen were assessed. Maternal and infant urine samples were tested for cotinine, cannabinoids, opiates, amphetamines, methadone, cocaine, and benzodiazepines.
  
  
  RESULTS
  The S and SM infants had a greater decline in minute volume (P = 0.037, P = 0.016, respectively) and oxygen saturation (P = 0.031) compared to controls. In all groups, the magnitude of decline in minute volume in response to hypoxia was higher in the neonatal period compared to at 6-12 weeks (P < 0.001).
  
  
  CONCLUSIONS
  Both maternal substance misuse and smoking were associated with an impaired response to a hypoxic challenge at the peak age for SIDS. The hypoxic ventilatory decline was more marked in the neonatal period compared to the peak age for SIDS indicating a maturational effect. Pediatr Pulmonol. 2017;52:650-655. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Kamal
authors.initials: K
authors.lastname: Ali
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosser
authors.affiliation: Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Ravindra
authors.initials: R
authors.lastname: Bhat
authors.affiliation: Addiction Sciences Unit, King's College London, London, United Kingdom.
authors.forename: Kim
authors.initials: K
authors.lastname: Wolff
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Hannam
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom.
authors.forename: Gerrard F
authors.initials: GF
authors.lastname: Rafferty
authors.affiliation: Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, United Kingdom.|Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom.|National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom.
authors.forename: Anne
authors.initials: A
authors.lastname: Greenough
mesh_terms: D000328:Adult; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D000860:Hypoxia / Q000503:physiopathology*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009035:Mothers; D011247:Pregnancy; D011446:Prospective Studies; D012119:Respiration; D012907:Smoking / Q000009:adverse effects*; D019966:Substance-Related Disorders / Q000150:complications*; D013398:Sudden Infant Death / Q000209:etiology*
keywords: Sudden infant death syndrome; maternal smoking; maternal substance misuse; opioids