Site of upper airway obstruction in preterm infants with problematical apnoea

Airway obstruction is an important factor predisposing to the development of apnoea in preterm infants. An ultrafine fibreoptic scope was used to examine the upper airway of 12 preterm infants with recurrent problematical apnoea. Continuous visualisation of the airway was possible and recorded on to videotape together with simultaneous cardiorespiratory monitoring to detect apnoeic episodes in 12 infants studied. In seven infants obstruction was observed at laryngeal level with the arytenoid masses and aryepiglottic folds closing across the vocal cords. This was not only observed in obstructive apnoea but also during mixed apnoea in periods where no respiratory effort was detectable and again in apparently pure central apnoea. The findings confirm the larynx as an anatomical site of upper airway obstruction. They agree with other indirect methods of assessing airway patency that obstruction has an important role in the pathophysiology of apnoea of prematurity.