pnoea duration and changes in cardiorespiratory and cerebrovascular responses in preterm neonates: a systematic review and meta-analysis.
Chen Y., Zandvoort CS., Baxter L., Fatunla OAT., Ketheeswaranathan V., Poorun R., Small Z., Usman F., Henry M., Berthouze L., Villarroel M., Hartley C.
BACKGROUND: Apnoea is a common respiratory complication in preterm neonates, leading to substantial changes in physiology. We conducted this systematic review and meta-analysis to examine the relationship between apnoea duration and changes in heart rate, oxygen saturation, cerebral oxygenation and cerebral blood volume in preterm neonates, and to identify factors that modulate this relationship. METHODS: We searched Medline, EMBASE, PsycINFO, and Cochrane Central Register of Controlled Trials databases and included primary empirical studies examining the relationship between apnoea or respiratory pause duration and at least one outcome in hospitalised neonates with postmenstrual age (PMA) <37 weeks. Through meta-analyses, we prospectively examined factors that may modulate this relationship, including postmenstrual age, medication use, and apnoea type. RESULTS: Forty-two papers were included, involving a total of 1483 neonates with 2399 study sessions. The decrease in heart rate, oxygen saturation, and cerebral oxygenation were significantly correlated with apnoea duration. PMA significantly modulated the relationship, with younger neonates more likely to exhibit oxygen desaturation from short apnoeas. CONCLUSIONS: Cardiorespiratory and cerebrovascular responses to apnoea are correlated with apnoea duration, yet wide variability exists in the response. Further research is needed to identify how factors modulate the relationship. IMPACT: Systematic review and meta-analysis of the relationship between apnoea duration and change in heart rate, oxygen saturation, cerebral oxygenation and cerebral blood volume in preterm neonates. Through meta-analysis, we demonstrate that postmenstrual age plays a significant modulating role in the relationship between apnoea duration and change in oxygen saturation, with younger infants more likely to have desaturations. Apnoea can lead to significant cardiorespiratory and cerebrovascular changes; understanding the factors which modulate these relationships are key to facilitating personalised alarm limits.