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Apnea of prematurity
     
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Apnea of prematurity

Apnea - newborns; AOP; As and Bs; A/B/D; Blue spell - newborns; Dusky spell - newborns; Spell - newborns; Apnea - neonatal

 

Apnea is breathing that slows down or stops from any cause. Apnea of prematurity refers to short episodes of stopped breathing in babies who were born before 37 weeks of pregnancy (premature birth).

Most premature babies have some degree of apnea.

Causes

 

There are several reasons why newborns, in particular those who were born early, may have apnea, including:

  • If their brain is not fully developed
  • If the muscles that keep the airway open are weak

Other stresses in a sick or premature baby may worsen apnea, including:

  • Anemia
  • Feeding problems
  • Heart or lung problems
  • Infection
  • Low oxygen levels
  • Temperature problems

 

Symptoms

 

The breathing pattern of newborns is not always regular and may be called "periodic breathing." This pattern is even more likely in newborns born early (preemies).

This irregular pattern is felt to be normal, but also thought of as immature.

It consists of short episodes (about 3 seconds) of either shallow breathing or stopped breathing (apnea). These episodes are followed by periods of regular breathing lasting 10 to 18 seconds.

Apnea episodes that last longer than 20 seconds are considered serious. The baby may also have a:

  • Drop in heart rate. This heart rate drop is called bradycardia or, sometimes, a "brady."
  • Drop in oxygen level (oxygen saturation). This is called desaturation or, sometimes a "desat."

 

Exams and Tests

 

These babies will be placed on monitors in the hospital.

  • The monitors keep track of their breathing, heart rate, and oxygen levels.
  • Apnea, drop in heart rate, or drop in oxygen level can set off the alarms on these monitors.

Drops in heart rate and oxygen levels may occur for other reasons than apnea (such as passing stool or moving around), so the monitor tracings are most often reviewed by the health care team.

 

Treatment

 

How apnea is treated depends on:

  • The cause
  • How often it occurs
  • Severity of episodes

Babies who are otherwise healthy and sometimes have few minor episodes are simply watched. In these cases, the episodes go away when the babies are gently touched or "stimulated" during periods when breathing stops.

Babies who are well, but who are very premature and/or have many apnea episodes, may be given caffeine. This will help make their breathing pattern more regular. Sometimes, the nurse will change a baby's position, use suction to remove fluid or mucus from the mouth or nose, or use a bag and mask to help with breathing.

Breathing can be assisted by:

  • Proper positioning
  • Slower feeding time
  • Oxygen
  • Continuous positive airway pressure (CPAP)
  • Breathing machine (ventilator) in extreme cases

Some infants who continue to have apnea but are otherwise mature and healthy will be discharged from the hospital on a home apnea monitor, with or without caffeine, until they have outgrown their immature breathing pattern.

 

Outlook (Prognosis)

 

Apnea is common in premature babies. Most babies have normal outcomes. Mild apnea does not appear to have long-term effects. However, preventing multiple or severe episodes is better for the baby over the long-term.

Apnea of prematurity most often goes away as the baby approaches their "due date." In some cases, this may last as long as the 44th week, such as in infants who were born very prematurely.

 

 

References

Carlo WA, Ambalavanan N. Respiratory tract disorders. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 101.

Martin RJ. Pathophysiology of apnea of prematurity. In: Polin RA, Abman SH, Rowitch DH, Benitz WE, Fox WW, eds. Fetal and Neonatal Physiology. 5th ed. Philadelphia, PA: Elsevier; 2017:chap 157.

Patrinos ME. Neonatal apnea and the foundation of respiratory control. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 75.

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        Review Date: 12/13/2017

        Reviewed By: Kimberly G Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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