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Stabilizing immature breathing patterns of preterm infants using stochastic mechanosensory stimulation

Department of ¹Neurology, University of Massachusetts Medical School, Worcester, Massachusetts ; Department of ²Pediatrics (Neonatology), University of Massachusetts Medical School, Worcester, Massachusetts and ; Department of ³Physiology, University of Massachusetts Medical School, Worcester, Massachusetts

Submitted 20 January 2009 ; accepted in final form 10 July 2009

Breathing patterns in preterm infants consist of highly variable interbreath intervals (IBIs) that might originate from nonlinear properties of the respiratory oscillator and its input-output responses to peripheral and central signals. Here, we explore a property of nonlinear control, the potential for large improvement in the stability of breathing using low-level exogenous stochastic stimulation. Stimulation was administered to 10 preterm infants (postconceptional age: mean 33.3 wk, SD 1.7) using a mattress with embedded actuators that delivered small stochastic displacements (0.021 mm root mean square, 0.090 mm maximum, 30–60 Hz); this stimulus was subthreshold for causing arousal from sleep to wakefulness or other detectable changes in the behavioral state evaluated with polysomnography. We used a test-retest protocol with multiple 10-min intervals of stimulation, each paired with 10-min intervals of no stimulation. Stimulation induced an 50% reduction (P = 0.003) in the variance of IBIs and an 50% reduction (P = 0.002) in the incidence of IBIs > 5 s. The improved stability of eupneic breathing was associated with an 65% reduction (P = 0.04) in the duration of O₂ desaturation. Our findings suggest that nonlinear properties of the immature respiratory control system can be harnessed using afferent stimuli to stabilize eupneic breathing, thereby potentially reducing the incidence of apnea and hypoxia.

stochastic resonance; afferents; apnea; respiratory rhythm; wavelet transform