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Pediatr Pulmonol. 2018 Apr;53(4):483-491. doi: 10.1002/ppul.23907. Epub 2017 Nov 14.

The hypoxic test in preterm neonates reinvestigated.

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PériTox-INERIS laboratory UMR_I 01, Jules Verne University of Picardy, Amiens, France.
Department of Neonatal Medicine, University Hospital, Amiens, France.
Department of Pediatric Intensive Care Unit, University Hospital, Amiens, France.
Department of Pediatric Surgery, University Hospital, Amiens, France.



We currently lack a suitable gold-standard method for implementation on modern equipment to assess peripheral chemoreceptor sensitivity. The aim of the present study was to develop an accurate and reproducible method for assessing peripheral chemoreceptors sensitivity in sleeping preterm neonates.


A poïkilocapnic hypoxic test was performed twice during rapid eye movement sleep (REM sleep) and non-rapid eye movement sleep (nonREM sleep). The infant breathed hypoxic gas (15% O2 ) for 60 s. The ventilatory response to hypoxia was assessed by comparing minute ventilation during the control period (21% O2 ) with successive 4-cycles sequences during hypoxia. We detected the first statistically significant increase in minute ventilation and recorded the corresponding response time.


During normoxia, minute ventilation was higher during REM sleep than in nonREM sleep (428.1 mL · min-1  · kg-1 [307.7-633.6]; 388.8 mL · min-1  · kg-1 [264.7-608.0], respectively; P = 0.001). After hypoxia, minute ventilation increased in both REM and nonREM sleep. The response was significantly higher in REM than in nonREM (25.3% [10.8-80.0] and 16.8% [7.5-33.2], respectively; P = 0.005). The intraclass correlation coefficients for all respiratory parameters were above 0.90.


We have developed a highly reliable method for assessing peripheral chemoreceptors sensitivity at the response time to hypoxia. In the future, researchers could use this method to assess the involvement of peripheral chemoreceptors in infants who experience chronic hypoxia (e.g. in bronchopulmonary dysplasia and recurrent apnea).


hypoxic ventilator responses; neonatal control of breathing; peripheral chemoreceptors; sleep and breathing


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