Breathing and brain development in hospitalised neonates

An immature brain-respiratory control mechanism predisposes the neonate to increased risk of breathing interruptions, including apnoeas, and these may disrupt long-term brain development. Electroencephalography has reliably been used to assess immediate brain function and for prognostication. Given the interactions between the respiratory and nervous systems, including neuro-developmental complications, it is important to identify early the immediate effect of respiratory changes on brain function which might contribute to long-term outcomes. To do this, I conducted a systematic review (Chapter 2) summarising the effect of periods of acute respiratory events and respiratory stimulants on EEG activity in neonates.Variations exist in individual brain development trajectories modulated by genetics and the environment. These disparities may better explain neonatal apnoea risk than age, supporting personalised care and prognostication. In Chapter 3, I assessed the value of brain maturity as a marker to help clinicians identify neonates with abnormal brain development relative to their actual age and inform apnoea treatment decisions. Finally, painful procedures are associated with apnoeas. Preterms undergo many painful procedures, including retinopathy of prematurity (ROP) screening, which coupled with the immature respiratory mechanisms and a vulnerable brain, increase the risk of complications. Swaddling has been shown to improve responses to painful procedures in neonates. To evaluate the effectiveness of a new swaddling device in reducing physiological instability, I compared changes in vital signs between neonates swaddled with the new device and neonates receiving standard care during ROP screening (Chapter 4). Overall, this thesis aims to inform neonatal care decisions by offering a comprehensive overview of the immediate interactions between neonatal breathing and brain function. It proposes brain biomarkers to detect the likelihood of apnoea in neonates and provides new insights into the effectiveness of a comfort measure for ROP screening. Ultimately, this thesis advocates for a more personalised approach to care.