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The Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri 63110
Received 23 December 1996; accepted in final form 17 March 1997.
Lijowska, Anna S., Nevada W. Reed, Barbara A. Mertins
Chiodini, and Bradley T. Thach. Sequential arousal
and airway-defensive behavior of infants in asphyxial sleep
environments. J. Appl. Physiol. 83(1):
219-228, 1997.
Infants are prone to accidental asphyxiation.
Therefore, we studied airway-defensive behaviors and their relationship
to spontaneous arousal behavior in 41 healthy sleeping infants
(2-26 wk old), using two protocols:
1) infant was rebreathing expired
air, face covered by bedding material; and
2) infant was exposed to
hypercarbia, face uncovered. Multiple measurements of respiratory and
motor activities were recorded (video, polygraph). The infants'
response to increasing hypercarbia consisted of four highly stereotyped
behaviors: sighs (augmented breaths), startles, thrashing limb
movements, and full arousal (eyes open, cry). These behaviors occurred
abruptly in self-limited clusters of activity and always in the same
sequence: first a sigh coupled with a startle, then thrashing, then
full arousal. Incomplete sequences (initial behaviors only) occurred
far more frequently than the complete sequence and were variably
effective in removing the bedding covering the airway. In both
protocols, as inspired CO2
increased, incomplete arousal sequences recurred periodically and with
increasing frequency and complexity until the infant either succeeded
in clearing his/her airway or was completely aroused. Spontaneous
arousal sequences, identical to those occurring during hypercarbia,
occurred periodically during sleep. This observation suggests that the
infant's airway-defensive responses to hypercarbia consist of an
increase in the frequency and complexity of an endogenously regulated,
periodically occurring sequence of arousal behaviors.
sigh; augmented breaths; startle; carbon dioxide response; sudden infant death syndrome; accidental suffocation; positional asphyxia
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