Synergistic behavior of inspiratory muscles after diaphragmatic fatigue in the newborn.

We studied diaphragmatic and intercostal muscle activity and the pattern of motion of rib cage and abdomen after diaphragmatic muscle fatigue in 15 newborn infants (birth wt 1,251 +/- 424 g, mean +/- SD). Rib cage and abdominal motion were monitored with magnetometers and intercostal and diaphragmatic electromyograms (EMG's) with surface electrodes. Twelve infants showed a total of 66 episodes of muscle fatigue identified by EMG frequency spectrum analysis. Two patterns of responses to fatigue were observed. In the first case, five infants consistently recruited their intercostal muscles; this was followed by a normalization of the diaphragmatic frequency spectrum. In these infants, recruitment of intercostal muscles successfully prevented any clinical deterioration. In the second, seven infants showed no change in their intercostal muscle activity, and diaphragmatic fatigue was followed by apnea. We conclude that in newborn infants the synergistic behavior of the diaphragm and intercostal muscles can maximize the performance of these muscles and, in some infants, seems to prevent development of apnea.