Control of Breathing

The successful transition from fetal to postnatal life requires respiration to become continuous for effective gas exchange to occur. Unfortunately, preterm infants are not always ready to make that transition and, in very preterm infants, apnea of prematurity is almost universal. Effective control of breathing involves input from central and peripheral chemoreceptors peripheral mechanoreceptors, and maturation of brainstem neurochemistry. It also requires coordinated activation of both the diaphragm and upper airway muscles to ensure upper airway patency. The mainstays of treatment for apnea of prematurity are continuous positive airway pressure (CPAP), which sustains lung volume and ensures airway patency, and caffeine, which enhances respiratory drive although may also have anti-inflammatory benefits. The long-term consequences of apnea of prematurity are unclear, but center around the implications of resultant hypoxic episodes. Sudden infant death syndrome (SIDS) does not appear to be a consequence of apnea of prematurity, although the incidence is higher in former premature infants as a result of multifactorial neurologic, cardiorespiratory and socioeconomic etiologies