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Neonatal pattern of breathing during active and quiet sleep after maternal administration of meperidine

, : Neonatal pattern of breathing during active and quiet sleep after maternal administration of meperidine. Pediatric Research 32(4): 412-416

The aim of this study was to reappraise the effects of maternal meperidine administration on breathing pattern during the first hours of life taking into account the state of alertness. Because breathing instability is more pronounced during active sleep, we hypothesized that meperidine administration might create a greater risk for respiratory instability during active sleep, the prominent sleep state in newborns. We studied eight full-term, healthy newborns whose mothers had received a continuous i.v. infusion of meperidine (81 +- 9 mg ) that was terminated 5.5 +- 2.1 h before delivery. These infants were compared with a control group of eight full-term newborns whose mothers did not receive any opioids. In both groups, all babies were delivered vaginally after a normal labor and had Apgar scores of 9 or 10 at 1 and 5 min. Neonatal gastric secretion and maternal venous and umbilical venous blood were sampled at delivery for determination of meperidine concentration. From 60 to 300 min after delivery, behavioral sleep states and thoracic and abdominal movement as well as transcutaneous arterial oxygen saturation (SaO-2) were monitored continuously. The number of apneic spells lasting more than 3 s during 100 min of recording and the percentage of time with SaO-2 below 90% in each sleep state were recorded. During quiet sleep, all respiratory variables were similar in both groups. During active sleep, there were significantly more apneic episodes (37.1 +- 25.1 versus 11.2 +- 13.9) and a higher percentage of time with SaO-2 lt 90% (14.3 +- 16.7% versus 1.3 +- 1.5%) in the meperidine group than in the control group (p lt 0.01). In addition, the percentage of time with SaO-2 lt 90% was significantly correlated with maternal meperidine dose (p lt 0.02), drug-delivery interval (P lt 0.01), and gastric concentrations of meperidine (p lt 0.01). These data show that maternal administration of meperidine induces respiratory abnormalities in healthy, full-term newborns that occur only during active sleep. This result indicates that the state of alertness has to be characterized during the monitoring of long-term neonatal respiratory effects of any narcotic agent. In addition, we speculate that maternal meperidine administration may provoke more severe respiratory disturbances in at-risk neonates and that respiratory monitoring during the first hours of life may be useful in these newborns.


PMID: 1437393

DOI: 10.1203/00006450-199210000-00009

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