Diaphragmatic electromyography monitoring in preterm infants

This thesis starts in Chapter 1 with general aspects of prematurity and its consequences on the respiratory system. Thereby, common types of respiratory failure in preterm infants, the physiology of respiratory muscles and different cardiorespiratory monitoring techniques used in the neonatal intensive care unit are described. The aim of this thesis is to explore if transcutaneous electromyography of the diaphragm (dEMG) can be used as a novel cardiorespiratory monitoring technique for preterm infants. Chapter 2 consists of a prospective cohort study in which the feasibility of dEMG as a cardiorespiratory monitor for preterm infants with a gestational age less than 32 weeks is determined and compared to chest impedance. In Chapter 3, a case report illustrates if transcutaneous dEMG can be used to detect a hemidiaphragmatic paresis in a preterm infant. Chapter 4 describes the effect of a loading dose of caffeine on the electrical activity of the diaphragm, tidal volume and endexpiratory lung volume in preterm infants by measuring dEMG and respiratory inductance plethysmography after caffeine administration. In Chapter 5, the effect of weaning from nasal continuous positive airway pressure to low flow nasal cannula on diaphragmatic activity is described. In Chapter 6, we determined if dEMG is able to classify apnea of prematurity correctly into central, obstructive or mixed when compared to chest impedance. Finally, Chapter 7 and 8 provides a, respectively, English and Dutch summary of this thesis and the most important results are discussed and future perspectives are outlined.