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by Woods M

Apnea of Prematurity

Definition

Apnea of prematurity is a temporary stop in breathing in infants. It usually lasts 15-20 seconds, but can also be diagnosed if less than 15 seconds when a slowed heart rhythm or other symptoms occur. It is most common in premature infants, but can rarely occur in full term infants as well. In general, the more premature the infants the more likely apnea will happen.

Causes

Apnea may be caused by problems with the nervous system, weak muscles in the airway, or a combination of both.
Breathing is controlled by the brain. The brain should both sense the need for increased breathing and stimulate the body to breathe. Immature nervous systems, like those in premature infants, may not be able to do these functions well. This type of apnea is known as central apnea.
Premature infants may also have weak muscles around the airway. The muscles cannot properly support the airway and keep it open, making breathing difficult. This type of apnea is known as obstructive apnea.
Certain medications, such as opioids, prostaglandin, and magnesium sulfate, can also suppress the body’s urge to breathe.
Normal Upper Airway During Sleep
IMAGE
Copyright © Nucleus Medical Media, Inc.

Risk Factors

Factors that increase the chance of apnea of prematurity may include:
  • Birth before 35 weeks of pregnancy—the earlier the birth, the greater the risk
  • Receiving certain medications
Factors that may worsen the apnea include:
  • Anemia
  • Heart or lung problems
  • Low oxygen in the blood—hypoxemia
  • Feeding difficulty
  • Temperature control problems
  • Infections
  • Overstimulation

Symptoms

Symptoms occur in the first week of life. Symptoms may include:
  • Long pauses between breaths
  • Bluish skin color
  • Slow heart rate

Diagnosis

Breathing and heart rates are monitored in most premature babies for at least the first few days.
At the initial onset of apnea:
  • Your baby will be examined closely.
  • Your baby’s bodily fluids may be tested. This can be done with blood tests.
  • Images may be taken of your baby’s chest or head. This can be done with an X-ray or ultrasound.
The doctor will measure chest movements and nasal air flow at the same time. This can help determine if central apnea, obstructive apnea, or a combination of both are present.

Treatment

Apnea of prematurity will go away on its own as the infant approaches what would have been the 36th week of gestation.
Treatment may be needed until the apnea resolves. Options will depend on how frequent and severe the apnea episodes are and the infant’s overall health. Most premature infants will be hospitalized during the time that apnea is present. Part of care will include heart rate and breathing monitoring. The monitors will sound an alarm when abnormal breathing is present.
Rubbing or patting the baby during an episode can stimulate breathing to start again. Infants with mild and infrequent episodes can simply be monitored and stimulated when needed. More frequent episodes may require:

Medications

Medicinal caffeine may be used to help stimulate breathing.

Supportive Care

A continuous positive airway pressure (CPAP) machine can help take over breathing if there is a long pause. This machine provides gentle pressure in the airways to help keep airways open and provide oxygen.
Other steps that may help decrease the frequency of episodes include:
  • Maintaining a comfortable and quiet climate
  • Removing nasal secretions
  • Careful positioning
Parents and caregivers should be trained to administer CPR in the event of an emergency.

Prevention

There is no known way to prevent apnea of prematurity. Since the apnea is related to prematurity, decreasing the risk of premature birth may help. Some cases of premature birth may be prevented with early and proper prenatal care, and good health of the mother during pregnancy. General tips for a healthy pregnancy include:
  • Eat a healthful diet and take recommended vitamins.
  • Avoid smoking, drinking alcohol, and taking drugs.
  • Only take medications that your doctor has approved.
  • Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs) or selective serotonin reuptake inhibitors (SSRIs). Talk to your doctor about alternatives that may be safer.

RESOURCES

Healthy Children—American Academy of Pediatrics
http://www.healthychildren.org
Kids Health—Nemours Foundation
http://kidshealth.org

CANADIAN RESOURCES

Caring for Kids—Canadian Paediatric Society
http://www.caringforkids.cps.ca
Health Canada
http://www.hc-sc.gc.ca

References

Apnea in premature infants. Children’s Healthcare of Atlanta website. Available at: http://www.choa.org/Childrens-Hospital-Services/Pulmonology/Apnea/Apnea-of-Prematurity. Accessed May 4, 2016.
Apnea of prematurity. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114149/Apnea-of-prematurity. Updated January 22, 2016. Accessed October 3, 2016.
Apnea of prematurity. Johns Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/healthlibrary/conditions/adult/pediatrics/apnea%5Fof%5Fprematurity%5F22,ApneaOfPrematurity. Accessed May 4, 2016.
Apnea of prematurity. Nemours Kids Health website. Available at: http://kidshealth.org/en/parents/aop.html. Updated October 2014. Accessed May 4, 2016.
Apnea of prematurity. University of Rochester Medical Center website. Available at: https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02922. Accessed May 4, 2016.

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