Bradycardia and hypoxaemia due to position-dependent hypoperfusion of the brain stem in a preterm infant.

UNLABELLED: The case is reported of a male baby with a decreased time average velocity of the basilar artery to 32%, measured by Doppler sonography in dextro-rotated head position. The decrease was due to a hypoplastic right vertebral artery with compression of the contralateral vertebral artery at the craniocervical junction during dextro-rotation of the head. This finding was more prominent in prone than in supine position. A decrease in oxygen saturation and heart rate to < 70% and 60 bpm, respectively, was monitored during dextro-rotation. The polysomnography also revealed postural-dependent bradycardia, decrease of the oxygen saturation, and rising carbon dioxide partial tension in prone position with dextro-rotation of the head.

CONCLUSION

Hypoperfusion of the brain stem caused by postural changes leads to further clinically relevant changes. Therefore an association with an acute life-threatening event and sudden infant death syndrome is speculated.