Transcutaneous electromyography of the diaphragm of newborn infants

The diaphragm is an important respiratory muscle and plays an important role in
the neonatal respiration and neonatal pulmonary transition. Transcutane
measurements of the electrical activity of the diaphragm (dEMG) gave us insight
in the control of breathing in children and neonates. However, the role of the
diaphragm in the control of breathing in preterm neonates and during the
pulmonal transition in term neonates is unclear. Therefore, dEMG in (preterm)
neonates is useful and clinically relevant.

Transcutaneous dEMG in premature neonates is feasible. This research project
investigates the physiology of control of breathing, pathophysiology of
respiratory disorders, detection of spontaneous breaths and the outcome of
respiratory and pharmacotherapy treatments in premature newborns.
The aim of this research project is to achieve improved respiratory monitoring
which will lead to improved pulmonary and neurological outcome.
In preterm and in term neonates we also investigate which role the diaphragm
plays during the neonatal pulmonary transition. This information is important
to determine the need and type of respiratory assistance at birth.

1. Feasibility and reproducibility of transcutaneous (tc) dEMG on premature
neonates.
- Are the signal quality (heart rate and respiratory rate), bradycardias and
apneas similar to the current impedance monitoring
2. Can we differentiate between central versus obstructive apneas with tc-dEMG.
3. What is the effect on diaphragm activity after an upload dose Caffein or
Dopram.
4. What is the effect on diaphragm activity when we change respiratory support
from nCPAP to the 'flowsnor' and what are the predictive values of success or
failure by change from nCPAP to 'flowsnor'.
5. Which role plays the diaphragm during neonatal pulmonary transition measured
by tc-dEMG in term neonates.
6. Which role plays the diaphragm during neonatal pulmonary transition measured
by tc-dEMG in preterm neonates.
7. Is transcutaneous dEMG superior to the Graseby capsule in detection of
spontaneous breaths?

Observational Prospective Cohort study

Burden, benefit and risks:
Although there will be no direct benefits for enrolled patients, the results of
this study will improve our knowledge about the diaphragm during respiration
and will lead to more optimal treatments for future preterm neonates. Tc-dEMG
has been conducted by former investigators on infants and neonates in the Emma
Childrens Hospital, AMC and no burden was described. Because of the
observational, non-invasive character of tc-dEMG and because no burden was
described on infants and neonates, we assume this will be the same for our
population.

Group relatedness:
We study the role of the diaphragm in the control of breathing in (premature)
newborns. Therefore we can not perform this study in another population than
(premature) newborns.