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The effect of vibrotactile stimulation on hypoxia-induced irregular breathing and apnea in preterm rabbits

Pediatric Research (2024)Cite this article

Abstract

Background

Manual tactile stimulation is used to counteract apnea in preterm infants, but it is unknown when this intervention should be applied. We compared an anticipatory to a reactive approach using vibrotactile stimulation to prevent hypoxia induced apneas.

Methods

Preterm rabbit kittens were prematurely delivered and randomized to either group. All kittens breathed spontaneously with a positive airway pressure of 8 cmH2O while they were imaged using phase contrast X-ray. Irregular breathing (IB) was induced using gradual hypoxia. The anticipatory group received stimulation at the onset of IB and the reactive group if IB transitioned into apnea. Breathing rate (BR), heart rate (HR) and functional residual capacity (FRC) were compared.

Results

Anticipatory stimulation significantly reduced apnea incidence and maximum inter-breath intervals and increased BR following IB, compared to reactive stimulation. Recovery in BR but not HR was more likely with anticipatory stimulation, although both BR and HR were significantly higher at 120 s after stimulation onset. FRC values and variability were not different.

Conclusions

Anticipated vibrotactile stimulation is more effective in preventing apnea and enhancing breathing when compared to reactive stimulation in preterm rabbits. Stimulation timing is likely to be a key factor in reducing the incidence and duration of apnea.

Impact

  • Anticipated vibrotactile stimulation can prevent apnea and stimulate breathing effort in preterm rabbits.

  • Anticipated vibrotactile stimulation increases the likelihood of breathing rate recovery following hypoxia induced irregular breathing, when compared to reactive stimulation.

  • Automated stimulation in combination with predictive algorithms may improve the treatment of apnea in preterm infants.

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Fig. 1: Experimental procedure for the anticipatory and reactive group.
Fig. 2: Set-up of the vibrotactile stimulation device.
Fig. 3: Visualization of data analysis.
Fig. 4: Visualization of study results.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors gratefully acknowledge the support provided by the SPring-8 synchrotron facility (Japan), which was granted by the SPring-8 Program Review Committee, for providing access to the X-ray beamline and associated facilities (Proposal 2017B0132). We acknowledge travel funding provided by the International Synchrotron Access Program (ISAP) managed by the Australian Synchrotron, part of ANSTO, and funded by the Australian Government (AS/IA173/12909).

Funding

The research was supported by an NHMRC Program Grant (APP113902) and the Victorian Government’s Operational Infrastructure Support Program. KL and MK acknowledge travel funding provided by the International Synchrotron Access Program (ISAP) managed by the Australian Synchrotron and Funded by the Australian Government (AS/IA173/12909). EM was supported by a Monash University Bridging Postdoctoral Fellowship (BPF17-0066) and a NHMRC Peter Doherty Biomedical Early Career Fellowship (APP1138049). AP was the recipient of a Vidi grant, The Netherlands Organization for Health Research and Development (ZonMw), part of the Innovational Research Incentives Scheme Veni-Vidi-Vici (NWO-Vidi 91716428). MT was supported by a NHMRC Early Career Fellowship (APP1111134). SH was supported by an NHMRC Principal Research Fellowship (APP1058537). MK was supported by an ARC Australian Research Fellowship (FT160100454).

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Authors and Affiliations

  1. Willem-Alexander Children’s Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, the Netherlands

    Sophie J. E. Cramer, Janneke Dekker, Tessa Martherus & Arjan B. te Pas

  2. School of Physics and Astronomy, Monash University, Melbourne, VIC, Australia

    Michelle K. Croughan, Katie L. Lee & Marcus J. Kitchen

  3. School of Earth and Environmental Science, University of Queensland, Brisbane, QLD, Australia

    Katie L. Lee

  4. The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia

    Kelly J. Crossley, Erin V. McGillick, Megan J. Wallace, Marcus J. Kitchen & Stuart B. Hooper

  5. Department of Obstetrics and Gynecology, Monash University, Melbourne, VIC, Australia

    Kelly J. Crossley, Erin V. McGillick, Megan J. Wallace & Stuart B. Hooper

  6. Women’s Newborn Research Centre, The Royal Women’s Hospital, Melbourne, VIC, Australia

    Martha Thio

  7. Centre of Research Excellence in Newborn Medicine, Murdoch Children’s Research Institute, Melbourne, VIC, Australia

    Martha Thio

  8. Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, VIC, Australia

    Martha Thio

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  1. Sophie J. E. Cramer
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Contributions

SC, AP, and SH made substantial contributions to conception and design of the study. SC, JD, MC, KL KC, EM, TM, AF, MT, MW, MK, SH and AP performed experiments and obtained data. Data was analyzed and interpreted by SC, JD, MC, MK, SH and AP. The first version of the manuscript was drafted by SC, JD, SH, and AP. All authors are acknowledged for their critical revision of the manuscript and approval of the final version.

Corresponding author

Correspondence to Sophie J. E. Cramer.

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The authors declare no competing interests.

Informed consent

All animal procedures were approved by the SPring-8 Animal Care and Monash University’s Animal Ethics Committees. Informed consent was not required.

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Cramer, S.J.E., Dekker, J., Croughan, M.K. et al. The effect of vibrotactile stimulation on hypoxia-induced irregular breathing and apnea in preterm rabbits. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03061-2

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  • DOI: https://doi.org/10.1038/s41390-024-03061-2

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