Apnea means a pause or temporary cessation of breathing for longer than 20 seconds. While it can happen in full-term babies, it is more common in premature babies. The more premature a baby’s birth, the higher the chances of developing apnea of prematurity (AOP). About half of all babies born prematurely have apnea.
Read to know more about symptoms, diagnosis, treatment, and tips to manage apnea in premature infants.
Causes Of Apnea Of Prematurity
In premature babies, the spinal cord and parts of the brain responsible for breathing are immature and do not allow non-stop breathing. Preterm infants have periods of heavy breathing followed by periods of shallow breathing or paused breathing.
Some other conditions and problems may also lead to apnea of prematurity, especially in full-term babies. These reasons may include the following (1).
- Bleeding in the brain
- Damage to the brain
- Lung problems
- Very high or very low levels of glucose or calcium in the body
- Heart or blood vessel problems
- Reflexes that may get triggered from feeding tubes, suctioning, or baby’s neck position
- Alterations in body temperature
Apnea in prematurity co babies can be one of these three types: central apnea, obstructive apnea, and mixed apnea. Read more about apnea in babies here.
Symptoms Of AOP In Babies
The following are the most common symptoms of apnea of prematurity in babies (2) .
- Periods of absent breathing for 20 seconds or more
- Apnea that begins to appear during the first week of life or later
Signs of more serious forms of apnea of prematurity include:
- Longer periods of no breathing
- Blue discoloration
- Bradycardia (slow heart rate)
- Symptoms that begin to show immediately after birth or after the second week of life
The symptoms of apnea of prematurity may resemble other conditions or medical problems such as periodic breathing. Apnea of prematurity is apnea predominantly associated with premature infants. Apnea during sleep in full-term infants is called sleep apnea. You may read more about sleep apnea in full-term babies here.
Diagnosis Of AOP
The doctor will check for pauses in breathing, indicating apnea of prematurity. The doctor may conduct any of the following tests, depending on the baby’s age and overall health, to determine any underlying cause.
- Physical examination
- Blood tests to check cell count, oxygen level, electrolyte level, and infection markers
- X-ray to rule out any problems in the lungs, heart, or gastrointestinal system
- Studies to monitor breathing, heart rate, and oxygen levels
- Urine and stool tests
- Spinal tap (Lumbar puncture)
- Sleep studies to check the vital signs and oxygen levels
Treatment For AOP In Babies
Many preterm infants outgrow apnea of prematurity by the time they reach the gestational age of 36 weeks. If it does not resolve, the doctor may consider any of the following treatments.
1. General care
It usually involves the following procedures.
- Monitoring breathing and heart rate
- Controlling body temperature
- Ensuring proper body positioning
- Providing extra oxygen
- Rubbing the baby’s skin during an episode of apnea to assist breathing
Methylxanthine is used to stimulate breathing in babies with apnea of prematurity. The doctor may suggest other medicines, too, depending on other health problems. For instance, AOP triggered by infections could require treatment with antibiotics and other medications.
3. Nasal continuous positive airway pressure (CPAP)
A mechanical breathing machine is used to deliver a steady flow of air into the airway and the lungs. Nasal intermittent positive pressure ventilation may be added to CPAP.
Complications Of Apnea Of Prematurity
Untreated apnea of prematurity may increase the risk of the following complications in infants (1).
- Slow heart rate
- Low blood oxygen levels
- Long-term lung problems
- Abrupt respiratory failure
Home Care To Manage AOP In Babies
Most babies with AOP are premature and will stay at the neonatal intensive care unit (NICU) until all problems, including apnea of prematurity, are resolved. However, infants who have no clinically significant cardiopulmonary problems for a significant duration may be discharged by the doctor. If the baby is discharged and permitted to stay at home, parents may need to observe the following homecare steps(3).
1. Home monitoring
- A home cardiorespiratory monitor or oral caffeine may be prescribed for babies who are ready to go home but have occasional cardiopulmonary events.
- Some infants with spontaneous and non-interventional recovery from apneic episodes may be discharged with an apnea monitor.
- The doctor will help you use these devices and make you understand the possible red flags and how to manage or escalate them.
2. Baby positioning
- Infants must always sleep on their backs.
- The baby’s head must be kept in the midline, and the neck must be kept in a neutral or slightly extended position to prevent airway obstruction.
- Infants with apnea of prematurity are at risk of apnea, bradycardia, and oxygen desaturation when they sit in a car seat. Therefore, their oxygen levels must be monitored for 90 to 120 minutes while they are seated in the car seat before they are discharged from the hospital.
Frequently Asked Questions
- When do premature infants grow out of apnea?
Most premature infants grow out of sleep apnea by the time they attain 36 weeks of gestational age.
- How long do premature infants stay on CPAP?
The duration of CPAP treatment is highly variable from one infant to another. It could be needed for a few hours to as long as several months in some cases.
- What is a sleep apnea monitor?
A sleep apnea monitor is a machine that monitors the baby’s breathing and heart rate. It comes with an alarm that goes off in case of any inadvertent event, such as slow heart rate or cessation of breathing.
Apnea of prematurity is seen in many premature babies, and most babies outgrow the condition with time. Do not rush the discharge from the hospital as it can lead to complications. After discharge, ensure telephonic support and regular physical checkups to manage the baby’s health and avoid long-term complications.
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