The moving limbs have proprioceptive afferents that generate coordination between locomotion and respiratory rhythm in humans. 16 The synchronization of breathing patterns and leg movements has been documented in humans, which allows us to conclude that limb motion can increase breathing. 15 Using vibration on the soles of the feet or palms of the hand can stimulate joints proprioceptors, thereby supporting respiration by producing an inherent reflexive coupling between the respiratory rate and motion of the limbs. Tactile stimulation works by producing excitatory, nonspecific neuronal action in the brainstem centre, which in turn promotes respiratory work. 11, 12, 13, 14 Sensory stimulants, including tactile stimulation, may be beneficial in the care or avoidance of AOP. Apnoea termination can be achieved using sensory stimulation (tactile), which is usually provided in addition to oxygen support or the use of ventilators (bag or mask). 10 In most Neonatal Intensive Care Units (NICUs), pharmacotherapy is used in addition to respiratory care to treat apnoea of prematurity however, most preterm infants still develop apnoea, which calls for the caregiver to provide more support. Also, methylxanthine therapy (caffeine and theophylline), which blocks adenosine receptors (the backbone of central apnoea intervention), is often used as a treatment. Nasal intermittent positive pressure ventilation (NIPPV), continuous positive airway pressure (CPAP), and prone positioning are among the typical treatments used for AOP to avoid pharyngeal collapse and alveolar atelectasis. Repeated intermittent hypoxic spells and bradycardia that happen with apnoea may lead to changes in neural development, which result in an elevated rate of death or abnormal neurodevelopment such as blindness at 3 years of age or cerebral palsy. However, stopping breathing for even 5–10 s can be accompanied by bradycardia or a decline in oxygen saturation (SpO 2). 6, 7 Clinically significant apnoeas are apnoeas that persist more than 20 s, or that are associated with bradycardia and desaturations. 4, 5 Intermittent hypoxia, cardiovascular sequelae, retinopathy, and neurodevelopmental diseases are commonly associated with AOP. Apnoea of prematurity (AOP) refers to respiration stopping for a period of time (≥10–20 s), or associated with oxygen desaturation (SpO 2 ≤ 80% for ≥4 s) and bradycardia (heart rate <2/3 of baseline for ≥4 s) in preterm infants (<37 gestational weeks). Apnoea cessation and acquiring a normal respiration pattern is a milestone of normal development for many preterm infants. 1, 2, 3 Furthermore, preterm neonates face difficulties with regulation of temperature, oral feeding skills, and normal breathing control. The morbidity related to prematurity tends to persist in later life, often resulting in great psychological, physical, and economic costs. Preterm infants have higher degrees of learning disabilities, sensory deficits, cerebral palsy, and respiration diseases than full-term infants. Preterm birth may be a serious factor in neonates’ morbidity, mortality, and other long-term health concerns.
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