Stochastic resonance stimulation may decrease apnea of prematurity

1. Stochastic resonance (SR) stimulation is a novel, noninvasive, nonpharmacologic method of delivering subarousal vibration to infants via specialized mattresses.

2. The use of SR stimulation decreased rates of apnea of prematurity, oxygen desaturation, and some aspects of bradycardia in preterm infants.

Statement Rundown: Apnea of prematurity is a common problem in the neonatal intensive care unit (NICU), occurring in more than half of premature infants. The mainstay of current treatment involves mechanical ventilation and the use of methylxanthines. SR is a relatively novel method of introducing random noise into a system, with the goal of altering the system’s behavior. In this study, authors used a vibrating mattress to deliver SR stimulation at a subarousal level to premature infants at risk of apnea. With stimulation, the number of apnea events fell by half and the number, intensity, and duration of oxygen desaturation events fell by at least 20%. There did not appear to be an effect on the number or duration of bradycardia events, although their intensity was slightly improved. The study is limited by its single-center design with a small number of participants, all of whom were still receiving standard treatment for apnea of prematurity throughout the study. However, infants served as their own controls and the results are similar to those seen in a previous, smaller study. These results suggest that a larger, multi-center, randomized controlled head-to-head trial would be beneficial in defining the clinical utility of SR stimulation in the NICU.

Click to read the study, published today in Pediatrics

Relevant Reading: Stabilizing immature breathing patterns of preterm infants using stochastic mechanosensory stimulation.

In-Depth [randomized crossover study]: Participants included 36 premature infants in a level IIIB NICU in Massachusetts with at least one documented apnea or bradycardia event between April 2012 and July 2014. These infants’ standard mattresses were replaced with a SR mattress, which delivered gentle, low amplitude vibrations. Each infant served as his or her own control, with 30-minute intervals of alternating stimulation or no stimulation along with pre-, mid- and post-baseline periods of no stimulation for at least 1 hour. The number of apnea events was not sufficient to analyze at the infant level, however, when analyzed for the entire sample, there was a 50% reduction in events. In addition, there was an 18% reduction in the number of oxygen desaturation events, a 35% reduction in the duration of each event, and a 21% reduction in intensity (a composite outcome including the depth below a defined threshold and the length of the event) (95% CI: 5-29%, 33-37%, and 20-22%, respectively). There was no difference in the number or duration of bradycardia events; however, there was an 18% reduction in the intensity of each event (95% CI: 15-22%).

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