Physiologic response to moderate altitude exposure among infants and young children

Abstract

Substantial numbers of children are exposed to moderate altitude while traveling to mountain resorts with their families. Although there has been extensive study of the adult physiologic response to altitude exposure, few studies of infants and young children exist. This investigation examines the acute physiologic responses to moderate altitude exposure among young children and the relationship of these responses to the development of acute mountain sickness (AMS). Children 3 to 36 months old participated in the prospective observational study, which included baseline measurements at 1610 m and measurements after a 24-h exposure to 3109 m. Measurements included pulse and respiratory rate, end-tidal CO2, arterial oxygen saturation (pulse oximetry), cerebral tissue oxygenation (StO2) by near-infrared spectroscopy, middle cerebral artery resistive index by transcranial Doppler, lateral ventricle volumes (ultrasound), and clinical evaluation for the presence of acute mountain sickness (Children's Lake Louise Score). Twenty-four children (13 girls and 11 boys, age 14.5±10.2 months) participated. After acute exposure to 3109 m, these children showed an increase in respiratory rate from 45±13 to 51.9± 15 breaths/min (p<0.008), accompanied by a decrease of end-tidal CO2 from 31±3 to 28± 2 mm. Hg (p<0.001) and a reduction of arterial oxygen saturation from 95±2 to 91±2% (p< 0.001 StO2 also decreased from 78±8 to 67±13% (p<0.001), and this reduction appeared to be related to age (r=0.58, p< 0.05), with lower saturations found in younger children. No evidence of increased intracranial pressure, as assessed by middle cerebral artery resistive index, was seen during ascent. Seven subjects developed symptoms of AMS; however, no relationship was found between the physiologic changes observed and the presence of symptoms. Ascent from 1610 to 3109 m resulted in tachypnea, relative hypoxia, hypocapnia, and a reduction in cerebral tissue oxygenation (StO2). The reduction in StO2 appeared to be related to age, with infants appearing to be the most susceptible to cerebral tissue oxygen desaturation at high altitude. No relationship appears to exist between the presence of AMS and the physiologic measurements.