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INVITED REVIEW

HIGHLIGHTED TOPIC
Neural Control of Perinatal Respiration

Some aspects of clinical relevance in the maturation of respiratory control in infants

Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri

Two reflex mechanisms important for survival are discussed. Brain stem and cardiovascular mechanisms that are responsible for recovery from severe hypoxia (autoresuscitation) are important for survival in acutely hypoxic infants and adults. Failure of this mechanism may be important in sudden infant death syndrome (SIDS), because brain stem-mediated hypoxic gasping is essential for successful autoresuscitation and because SIDS infants appear to attempt to autoresuscitate just before death. A major function of another mechanism is to protect the airway from fluid aspiration. The various components of the laryngeal chemoreflex (LCR) change during maturation. The LCR is an important cause of prolonged apneic spells in infants. Consequently, it also may have a role in causing SIDS. Maturational changes and/or inadequacy of this reflex may be responsible for pulmonary aspiration and infectious pneumonia in both children and adults.

sudden infant death syndrome; apnea; autoresuscitation; hypoxic gasping; laryngeal chemoreceptors

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