Diaphragmatic electromyography in infants: an overview of possible clinical applications.

Preterm infants often experience breathing instability and a hampered lung function. Therefore, these infants receive cardiorespiratory monitoring and respiratory support. However, the current respiratory monitoring technique may be unreliable for especially obstructive apnea detection and classification and it does not provide insight in breathing effort.

Feasibility of wireless cardiorespiratory monitoring with dry electrodes incorporated in a belt in preterm infants.

Monitoring heart rate (HR) and respiratory rate (RR) is essential in preterm infants and is currently measured with ECG and chest impedance (CI), respectively. However, in current clinical practice these techniques use wired adhesive electrodes which can cause skin damage and hinder parent-infant interaction. Moreover, CI is not always reliable.

Diaphragm Activity Pre and Post Extubation in Ventilated Critically Ill Infants and Children Measured With Transcutaneous Electromyography.

Objectives: Swift extubation is important to prevent detrimental effects of invasive mechanical ventilation but carries the risk of extubation failure. Accurate tools to assess extubation readiness are lacking. This study aimed to describe the effect of extubation on diaphragm activity in ventilated infants and children.

Transcutaneous monitoring of diaphragm activity as a measure of work of breathing in preterm infants.

Objective: Monitoring work of breathing (WOB) is important to assess the pulmonary condition and adjust respiratory support in preterm infants. Conventional WOB measurement (esophageal pressure, tidal volume) is invasive and we hypothesized that monitoring diaphragm activity could be a noninvasive alternative to estimate WOB. The objective was to determine the correlation between conventional WOB measures and diaphragm activity, in preterm infants.

Cardiorespiratory monitoring in the delivery room using transcutaneous electromyography.

Objective: To assess feasibility of transcutaneous electromyography of the diaphragm (dEMG) as a monitoring tool for vital signs and diaphragm activity in the delivery room (DR).

Design: Prospective observational study.

Setting: Delivery room.

Diaphragmatic electromyography in preterm infants: The influence of electrode positioning.

Objective: To determine the effect of changing electrode positions on vital signs and respiratory effort parameters measured with transcutaneous electromyography of the diaphragm (dEMG) in preterm infants.

Methods: In this observational study, simultaneous dEMG measurements were performed at the standard position and at one alternative electrode position (randomly assigned to lateral, superior, medial, inferior to the standard placement, or dorsal). The activity of the diaphragm was measured for 1 hour at both positions.

Doxapram Treatment and Diaphragmatic Activity in Preterm Infants.

Background: Doxapram is a treatment option for severe apnea of prematurity (AOP). However, the effect of doxapram on the diaphragm, the main respiratory muscle, is not known.

Objectives: To investigate the effect of doxapram on diaphragmatic activity measured with transcutaneous electromyography of the diaphragm (dEMG).

Patient-ventilator asynchrony in preterm infants on nasal intermittent positive pressure ventilation.

Objective: To describe the incidence of patient-ventilator asynchrony and different types of asynchrony in preterm infants treated with non-synchronised nasal intermittent positive pressure ventilation (nIPPV).

Design: An observational study was conducted including preterm infants born with a gestational age (GA) less than 32 weeks treated with non-synchronised nIPPV. During 1 hour, spontaneous breathing was measured with transcutaneous electromyography of the diaphragm simultaneous with ventilator inflations.

The Effect of Minimally Invasive Surfactant Therapy on Diaphragmatic Activity.

Background: Minimally invasive surfactant therapy (MIST) is increasingly used to treat preterm infants with respiratory distress syndrome (RDS). However, the effect of MIST on breathing effort is poorly studied.

Objectives: To describe the effect of MIST on neural breathing effort assessed with transcutaneous electromyography of the diaphragm (dEMG) in preterm infants with RDS.

Classifying Apnea of Prematurity by Transcutaneous Electromyography of the Diaphragm.

Background: Treatment of apnea is highly dependent on the type of apnea. Chest impedance (CI) has inaccuracies in monitoring respiration, which compromises accurate apnea classification. Electrical activity of the diaphragm measured by transcutaneous electromyography (EMG) is feasible in preterm infants and might improve the accuracy of apnea classification.

Breath detection by transcutaneous electromyography of the diaphragm and the Graseby capsule in preterm infants.

Objective: To compare triggering, breath detection and delay time of the Graseby capsule (GC) and transcutaneous electromyography of the diaphragm (dEMG) in spontaneous breathing preterm infants.

Methods: In this observational study, a 30 minutes respiration measurement was conducted by respiratory inductance plethysmography (RIP), the GC, and dEMG in stable preterm infants. Triggering was investigated with an in vitro set-up using the Infant Flow SiPAP system.

Diaphragmatic activity during weaning from respiratory support in preterm infants.

Objective: To determine if weaning from nasal continuous positive airway pressure (nCPAP) to lesser supportive low flow nasal cannula (LFNC) results in a change in electrical activity of the diaphragm in preterm infants.

Design: Prospective observational study.

Setting: Neonatal intensive care unit.

Mortality, neonatal morbidity and two year follow-up of extremely preterm infants born in The Netherlands in 2007.

Background: Extremely preterm infants are at high risk of neonatal mortality and adverse outcome. Survival rates are slowly improving, but increased survival may come at the expense of more handicaps.

Methodology/principal Findings: Prospective population-based cohort study of all infants born at 23 to 27 weeks of gestation in The Netherlands in 2007.