DETERMINANTS OF LUNG-VOLUME IN SPONTANEOUSLY BREATHING PRETERM INFANTS

To study the effects of apneic pauses, sighs, and breathing patterns o n functional residual capacity (FRC), we measured FRC repeatedly in 48 healthy preterm infants (weight at study 2,042 +/- 316 g [mean +/- SD ], postconceptional age 36.6 +/- 2.0 wk), during unsedated sleep using a modified heliox/nitrogen washout technique. Breathing movements and pulse oximeter saturation (Spot) were recorded throughout and recordi ngs analyzed for the presence of regular and nonregular breathing patt ern, apneic pauses, sighs, and desaturations (Sp(O2) less than or equa l to 90%) during the last 2 min prior to each FRC measurement. FRC was lower during nonregular than during regular breathing pattern (23.3 /- 7.2 ml/kg versus 26.9 +/- 7.8 ml/kg, p < 0.02); however, this appar ent effect of breathing pattern disappeared after controlling the data for apneic pauses. Apneic pauses resulted in a significant decrease i n FRC: mean FRC was 20.0 +/- 6.8 ml/kg if measured within 2 min of an apneic pause, 26.0 +/- 6.9 ml/kg if measured after a sigh (p < 0.001), and 24.0 +/- 7.7 ml/kg if there had been neither a sigh nor an apneic pause (p < 0.05). The interval between the apneic pause and the FRC m easurement had no effect on FRC. There was an inverse correlation betw een FRC and the speed with which Spot fell during desaturation (r = -0 .5, p < 0.03). Apneic pauses resulted in a persistent reduction in FRC in these preterm infants. Sighs appeared to restore FRC. The signific ant relationship between FRC and the speed of desaturation found in th is study underscores the importance of endogenous or exogenous strateg ies that help to increase FRC, such as sighs or the application of con tinuous positive airway pressure, for the stability of oxygenation in preterm infants who have difficulty maintaining their oxygenation.