Transcutaneous electromyography of the diaphragm: Monitoring breathing and the effect of respiratory support in preterm infants

This thesis focusses on the respiratory condition of preterm infants. Due to the immaturity of the respiratory system, preterm infants are prone for respiratory failure and they often need respiratory support. Accurate monitoring of breathing and monitoring of the effect of respiratory support is warranted to obtain objective information about the respiratory condition of each individual preterm infant.
Transcutaneous electromyography of the diaphragm (dEMG) is a non-invasive bedside tool to monitor the function of the diaphragm, the main respiratory muscle, and provides information on neural breathing effort.
The aim of this thesis was to investigate the possible use of transcutaneous dEMG in clinical care for preterm infants suffering from common respiratory diagnoses. It is shown that transcutaneous dEMG can be used to monitor breathing patterns and can improve the classification of apnea of prematurity. Furthermore, it can provide information on the working mechanism of pharmacological treatments for common respiratory diagnoses and it gives insight in the effect of weaning from respiratory support as well as the level of support given by different modes of non-invasive respiratory support. In addition, the interaction between spontaneous breathing and ventilator inflations is described and transcutaneous dEMG might be used for synchronisation of ventilator inflations with spontaneous breathing in future.
Based on the results presented in this thesis, transcutaneous dEMG seems to be a promising technique to improve and individualize respiratory treatment of preterm infants.