Diagnosis and treatment of neonatal cardiorespiratory events

Abstract

Neonatal cardiorespiratory monitoring is universal in preterm infants. The major problem encountered in this population is apnea or hypoventilation, however, monitoring respiration via impedance fails to identify many episodes. Hence, we are dependent on heart rate and oxygen saturation to ensure safe practice. In recent years the potential consequences of hypoxemic events have generated considerable interest. This has resulted in renewed efforts to optimize management strategies focused primarily on ventilatory support and xanthine therapy. While continuous positive airway pressure (CPAP) remains the mainstay of non-invasive ventilatory support, nasal intermittent positive pressure ventilation (NIPPV) is widely used as an alternative to intubation. Optimizing oxygenation remains a key target and automated oxygen delivery of supplemental oxygen provides great promise. Caffeine therapy is the gold standard to enhance respiratory drive while less evidence-based techniques to stabilize and standardize respiratory control continue to be studied. The term infant, on the other hand, presents a less common, but unique, diagnostic dilemma and clinical judgment must dictate the magnitude of investigation.