premature – attacks of spontaneous respiratory standstill at premature children owing to morphological and functional immaturity of certain structures of a brain. It is shown by respiratory standstill lasting not less than 20 seconds. Is followed by heartbeat delay, decrease in a saturation of blood and change of color of integuments (cyanosis or pallor). premature it is diagnosed by results of hardware monitoring. Respiratory standstill fact is also confirmed on lack of respiratory movements. Treatment includes oxygen support, medicamentous stimulation of breath, acceleration of maturing of structures of a bronchial tree.
premature occurs at 25-50% of the newborns who were born before the normal term of a gestation (37-42 weeks). A close state is so-called periodic breath of which duration of attacks, smaller on time, is characteristic, than at premature. It is important to understand that respiratory standstill at premature children arises with a high share of probability, at the same time the condition of prematurity is extremely urgent for pediatrics as, along with , attracts a set of other risks for the child's life. Especially it concerns the children who were born before the 30th week of a gestation. Besides, it is very difficult to diagnose respiratory standstill in the absence of the corresponding equipment, and long finding of the child on IVL is also fraught with negative consequences.
The main reason for spontaneous respiratory standstill – immaturity of the central and peripheral structures of nervous system. Miyelinization of the nervous fibers providing the act of breath normal comes to an end by 36-37 week of a gestation. All children born on earlier terms of pregnancy are subject to risk of development premature. Besides, respiratory standstill can be connected with direct defeat of brain structures owing to the pre-natal infections, meningitis, intra ventricular hemorrhages and other states which are often found at premature children.
It is known that newborns spend the most part of time in a dream. Premature kids sleep about 80% of time a day. In a REM sleep phase on the general immaturity of nervous system decrease in frequency of respiratory movements and a bigger weakening of the central control of breath, characteristic of the sleeping child, is imposed. Also at premature children pathological reaction to a hypoxia is observed. Deficiency of oxygen causes in them bradycardia and an urezheniye of breath instead of compensatory strengthening and increase of respiratory movements. Rarely premature obstruction of the top airways is the reason. Usually it is connected with weakness and an underdevelopment of a muscular framework.
Classification and symptoms premature
Allocate three forms premature: central, obstructive and mixed. The central and mixed mechanisms of respiratory standstill meet in 85-90% of cases. At the central apnoe attacks are connected with immaturity of nervous system. At the mixed genesis the obstruction of the top airways arising after the central respiratory standstill or promoting it takes place. On a share premature, connected only with obstruction, about 10-15% of cases are necessary. Also conditionally divide idiopathic and respiratory standstill developing against the background of various diseases (sepsis, anemia, meningitis, etc.)
It is possible to notice symptoms of respiratory standstill on change of skin color of the kid. is followed by cyanosis or pallor of integuments. The concern is absent, on the contrary, oppression of nervous system is noted. The state often is followed by symptoms of associated diseases. Spasms, including with consciousness loss can be observed. Symptoms of intoxication are characteristic of infectious pathologies: pneumonia, meningitis, sepsis of any etiology etc. In case of idiopathic apnoe of premature other symptoms, except respiratory standstill, does not come to light. As the condition of prematurity in most cases demands respiratory support, can be registered the special equipment.
Clinical signs are indirect and are not always noticeable to the pediatrician. The basis of diagnostics is made by data of hardware monitoring. premature are diagnosed at decrease in a saturation to 85% and below. Duration of an attack makes not less than 20 seconds. Attacks of smaller duration can be also considered premature if are followed by bradycardia with heart rate from 100 beats/min and below. Visually it is possible to notice respiratory standstill on easing or the termination of reductions of intercostal muscles and diaphragms. The same sign allows to distinguish the central and obstructive genesis as in the latter case the respiratory movements do not stop.
In all cases of respiratory standstill clarification of the reasons of development is necessary. As the central and mixed genesis premature most often takes place, diagnostics of a condition of a brain is performed. The neyrosonografiya is applied, according to indications the lyumbalny puncture allowing to reveal signs of an inflammation, vnutrizheludochky hemorrhage, and also to take material for crops for the purpose of definition of causative agents of pre-natal infections is carried out. Tumors of a brain, especially stem localization as in a trunk of a brain there is a respiratory center are excluded. Pneumonia is confirmed radiological. Signs of violations of nasal breath can be found at a forward rinoskopiya.
Treatment and the forecast at premature
Treatment is carried out in intensive care unit. The type of oxygen support is defined individually. Deeply premature children always are on IVL. In therapy the central stimulators of breath are used. Also metilksantina for the purpose of prevention of obstruction of airways are appointed. Use of surfactant for acceleration of maturing of an alveolar epithelium is possible. Therapy of other states accompanying prematurity is carried out. If necessary antibiotics are entered, antishock therapy is performed. The extract is possible after achievement of post-conceptual age of 36-37 weeks. Criterion of recovery lack of attacks premature within 7-10 days is considered.
The forecast is more often favorable. The exception is made by deeply premature children as degree of immaturity of nervous system and respiratory tract in this case is critical. Death can come both owing to attacks premature, and from associated diseases. In most cases respiratory function is stabilized in process of the maturing of an alveolar epithelium and structures of a brain regulating the act of breath. After an extract observation is shown to children, use of monitors , allowing to register attacks is quite often recommended.