Apnea of Prematurity

What is apnea?

Apnea is a term for the absence of breathing. It can occur in full-term babies, but is more common in premature babies. The more premature the baby, the greater the chances that apnea will occur. As an infant matures, he or she eventually improves and apnea associated with prematurity has usually resolved by one month post-term.

Apnea may be followed by bradycardia - a decreased heart rate. When breathing slows, the heart rate also slows. A common term for apnea with bradycardia is "As and Bs."

Apnea is considered a problem when infants have apnea that lasts longer than 20 seconds or is associated with a drop in heart rate (bradycardia) or decreased oxygen. Apnea can be "central," meaning no breathing movement or airflow. Obstructive apnea refers to cases when a baby is making breathing movements, but is not getting any air in the lungs (such as occurs when something is blocking the airway).

Another breathing pattern can also occur in both premature and full-term newborns, called periodic breathing, which is a pattern of short apneas followed by a burst of faster breaths. Periodic breathing is a normal type of breathing in babies. The amount of time infants spend periodic breathing decreases with advancing age.

What causes apnea of prematurity?

Apnea of prematurity may be due to a disturbance in the brain''s breathing control center. Problems in other organs can also affect the breathing control center. Apnea of prematurity may not have an identifiable cause other than immaturity of the central nervous system. However, apnea may have other causes. Some of these include:

• infections
• respiratory disease
• gastrointestinal problems such as reflux (when the stomach contents move back up into the esophagus or back of the throat)
• too low or too high levels of chemicals in the body, such as glucose or calcium
• unstable temperature
• heart or blood vessel problems
• anemia
• stimulation of reflexes that can trigger apnea such as with feeding tubes or suctioning, or when a baby''s neck is very flexed
• bleeding or tissue damage in the brain

If no cause is found for the apnea, then apnea of prematurity is the diagnosis. It is important to find out if there is a reasons for the apnea so treatment can be directed to that problem.

What are the symptoms of apnea of prematurity?

Symptoms of apnea of prematurity may include:

• periods of absent breathing
• apnea beginning right after birth or after the second week of life
• blue coloring, drops in oxygen (desaturation)
• decrease in heart rate (bradycardia)

The symptoms of apnea of prematurity may resemble other conditions or medical problems. Always consult your baby''s physician for a diagnosis. It is important to find out if there is another cause for the apnea so that treatment can be directed to that problem.

How is apnea of prematurity diagnosed?

It is important to find out if the apnea is due primarily to prematurity or if it is caused by another problem. Your baby''s physician will check many of your baby''s body systems to find out what might be causing the apnea. Diagnostic procedures may include:

• physical examination
• blood tests (checking for blood counts, electrolyte levels, and infection)
• measurement of the levels of oxygen in the baby''s blood
• x-ray (to check for problems in the lungs, heart, or gastrointestinal system) - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• monitoring breathing effort, heart rate, and oxygenation

Treatment for apnea of prematurity:

When apnea occurs, stimulation of the baby by rubbing the skin or patting can help the baby begin breathing again. However, any problems that might be causing the apnea need to be identified and treated, as noted above.

Specific treatment for apnea of prematurity will be determined by your baby''s physician based on:

• your baby''s gestational age, overall health, and medical history
• severity and frequency of the apnea 
• your baby''s tolerance for specific medications, procedures, or therapies  

Treatment for apnea of prematurity may include:

• monitoring of breathing and heart rates
• medications
  
  • caffeine or theophylline to stimulate the central nervous system
• oxygen or nasal cannula flow
• nasal continuous positive airway pressure (CPAP)

Many premature babies will "outgrow" apnea of prematurity by the time they reach 36 weeks gestation. Some infants may not resolve their apnea of prematurity until one month post-term.

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