LIBRO + ANEXOS NEUMOLOGÍA PEDIÁTRICA

Neumología Pediátrica. Anexos ❚ 225 2. Know that fetal breathing activity occurs only during REM sleep and is present about 40% of the time b. Hypoxic drive 1. Know that there is a maturation of hypoxic drive during infancy c. Hypercapnic drive 1. Understand factors that influence hypercapnic ventilatory response 2. Understand the interaction of the hypoxic and hypercapnic drives d. Periodic breathing 1. Know that hypoxemia can lead to periodic breathing in a healthy infant 2. Know that periodic breathing may occur in normal infants 3. Realize when periodic breathing is abnormal in infants e. Central Apnea 1. Know that short central apnea is normal in children of all ages 2. Know that prolonged apnea and bradycardia in preterm infants typically resolve by about 43 weeks post-conceptional age 2. Sleep a. NREM sleep 1. Pattern of breathing a. Know that NREM sleep is generally characterized by regular breathing 2. Control of breathing a. Know that chemical/metabolic stimuli control ventilatory rate and depth during NREM sleep b. Know that the slope of the ventilatory response curve is decreased during NREM sleep compared with the response during the awake state b. REM sleep 1. Pattern of breathing a. Know that paradoxical inward rib cage motion during inspiration is a normal characteristic of breathing during REM sleep in infants b. Know that an irregular breathing pattern is characteristic of REM sleep 2. Control of breathing a. Be able to compare the effects of REM sleep and NREM sleep on the ventilatory response to carbon dioxide b. Know that in REM sleep, as compared with NREM sleep, chemical control is less important and behavioral (cortical) control is of increased importance 3. Effect on postural muscles a. Recognize the effect of REM sleep on muscle tone of the postural muscles and upper airway muscles E. Measurement of respiratory drive 1. Techniques a. Understand the technique for ventilatory response testing in children 2. Normal response a. Recognize the pattern of the normal response to hypercapnia b. Recognize the factors that modify the normal response to acute hypoxia c. Recognize the effects of chronic high altitude exposures on respiratory drive d. Know the acute ventilatory responses to high altitude