Clinical associations with immature breathing in preterm infants: part 2-periodic breathing

Pediatr Res. 2016 Jul;80(1):28-34. doi: 10.1038/pr.2016.58. Epub 2016 Mar 22.


Background: Periodic breathing (PB) is a normal immature breathing pattern in neonates that, if extreme, may be associated with pathologic conditions.

Methods: We used our automated PB detection system to analyze all bedside monitor chest impedance data on all infants <35 wk' gestation in the University of Virginia Neonatal Intensive Care Unit from 2009-2014 (n = 1,211). Percent time spent in PB was calculated hourly (>50 infant-years' data). Extreme PB was identified as a 12-h period with PB >6 SDs above the mean for gestational age (GA) and postmenstrual age and >10% time in PB.

Results: PB increased with GA, with the highest amount in infants 30-33 wk' GA at about 2 wk' chronologic age. Extreme PB was identified in 76 infants and in 45% was temporally associated with clinical events including infection or necrotizing enterocolitis (NEC), immunizations, or caffeine discontinuation. In 8 out of 28 cases of septicemia and 10 out of 21 cases of NEC, there was a >2-fold increase in %PB over baseline on the day prior to diagnosis.

Conclusion: Infants <35 wk GA spend, on average, <6% of the time in PB. An acute increase in PB may reflect illness or physiological stressors or may occur without any apparent clinical event.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Caffeine / therapeutic use
  • Cohort Studies
  • Electric Impedance
  • Enterocolitis, Necrotizing / complications
  • Female
  • Gestational Age
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature / physiology
  • Intensive Care Units, Neonatal
  • Intensive Care, Neonatal
  • Male
  • Monitoring, Physiologic
  • Respiration
  • Respiration Disorders / complications*
  • Respiration Disorders / physiopathology*
  • Sensitivity and Specificity
  • Sepsis / complications
  • Time Factors


  • Caffeine