Taking a Deep Breath and Starting Life – Unique Breathing Patterns of Preterm Infants

How do very preterm babies breathe? What respiratory mechanisms help them manage the complex transition from intrauterine life to life outside the womb?

DZL-PI Vincent Gaertner (CPC-M, DZL site Munich) and his team at the Dr. von Hauner Children's Hospital in Munich explored this intriguing question. Their work, "Deciphering Mechanisms of Respiratory Fetal-to-Neonatal Transition in Very Preterm Infants”, investigates the specific breathing patterns of very preterm infants and their intrapulmonary gas flows during various breathing patterns immediately after birth. The study was published in the American Journal of Respiratory and Critical Care Medicine.

The researchers analyzed data from a previous randomized study involving preterm infants born between 26 and 32 weeks. Data from electrical impedance tomography were extracted for individual breaths, and the researchers identified three different breathing types within the first 10 minutes after birth:

• Tidal breathing (44% of all breaths; sinusoidal breathing without disturbance during exhalation)
• Braking (50%; braking maneuver with short duration during exhalation)
• Holding (6%; braking maneuver with long duration during exhalation)

Also, the researchers analyzed lung volumes and ventilation distribution for the end of inspiration, the end of the expiratory braking and/or holding maneuver, and the end of expiration. Interestingly, the lung volume of the preterm infants only increased after a braking maneuver with long duration (i.e. holding maneuver) at the end of a complete breath, increasing the infant’s functional residual capacity. Dr. Gaertner and his team concluded that the braking and holding maneuvers of preterm infants contribute to better lung ventilation. The resulting pendelluft flow prevents the backflow of lung fluid. Thus, the study deciphers the mechanisms for a successful transition from fetus to newborn and expands the understanding of this unique moment in life.

For this work, Dr. Gaertner was also awarded the Adalbert-Czerny Prize 2024 by the German Society for Pediatrics and Adolescent Medicine (DGKJ) at the Congress for Pediatrics and Adolescent Medicine. The prize is endowed with 10,000 euros and honors outstanding scientific achievements in the field of pediatrics.

In a video interview, Vincent Gaertner explains his research and sees it as a piece of the puzzle to give children more time for the complex adaptation processes after preterm birth and to reduce invasive ventilation.

Original publication: Gaertner VD, Büchler VL, Waldmann A, Bassler D, Rüegger CM. Deciphering Mechanisms of Respiratory Fetal-to-Neonatal Transition in Very Preterm Infants. Am J Respir Crit Care Med. 2024 Mar 15;209(6):738-747. doi: 10.1164/rccm.202306-1021OC. PMID: 38032260.