Images in Clinical Medicine
Kim Eagle, M.D., Editor
Periodic Breathing in an Infant with Hydrocephalus
N Engl J Med 1996; 334:1577June 13, 1996
- Article
Figure 1 A portion of a polysomnogram recorded in a neonate with congenital hydrocephalus and resultant periodic breathing shows frequent, short periods of central apnea, as demonstrated by the cessation of oronasal air flow and the absence of a wave form on the tracing for end-tidal partial pressure of carbon dioxide (PCO2), in association with the absence of chest- and abdominal-wall motion (arrows). Inspiration is represented by an upward deflection in the air-flow and chest- and abdominal-wall signals. There is a six-second delay in the recording of end-tidal PCO2. Oronasal air flow was measured with a thermistor.
During the night while sleeping, the infant had periodic breathing 50 percent of the time. Although no arterial oxygen desaturation is evident on this portion of the tracing, desaturation to 75 percent occurred during active sleep. The infant received a ventriculoperitoneal shunt as well as a blood transfusion for the treatment of coexisting anemia. Subsequent polysomnography while the infant was receiving 0.25 liter of supplemental oxygen per minute demonstrated periodic breathing 3 percent of the total sleep time, with no desaturation. The infant was sent home with an apnea monitor while still receiving supplemental oxygen. Polysomnography repeated at six months of age with the infant breathing room air demonstrated periodic breathing 12 percent of the total sleep time, with an arterial-oxygen-saturation nadir of 93 percent.
Kim Eagle, M.D.
Carole L. Marcus, M.D.
Johns Hopkins Children's Center, Baltimore, MD 21287
