Apnea Of Prematurity: Causes, Symptoms, Risks, And Treatment

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Apnea of prematurity (AOP) is a common problem, affecting nearly half of premature infants. It can be defined as a breathing pause or momentary cessation lasting more than 20 seconds. The chances of developing AOP increase with the prematurity of the neonate; however, it can also happen in full-term babies.

Read on to know more about symptoms, diagnosis, and treatment of AOP and tips to manage apnea in premature infants at home.

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
  • Infections
  • Reflux
  • 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 premature babies can be one of these three types: central apnea, obstructive apnea, and mixed apnea.

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.

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

2. Medications

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 when a newborn, especially one born prematurely, ceases breathing for short periods. This can be due to the inability of the brain and muscles to keep the airways open. Severe forms can be associated with longer periods of apnea or breathless episodes. Brain damage, lung problems, infections, and heart problems can contribute to apnea of prematurity in babies. After diagnostic testing, babies may require positive airway pressure and medications to manage this condition.

Key Pointers

  • Apnea in premature babies could be due to certain infections, bleeding, or damage to the brain.
  • The signs may include periods of short breathing, decreased heart rate, or bluish skin discoloration.
  • To determine blood oxygen levels, your doctor may perform a physical examination, sleep studies, and blood testing.
  • The treatment may include general care, antibiotic medications, or ventilator support.

References:

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Dr. Dur Afshar Agha

(MS)
Dr. Dur Afshar Agha is a consultant pediatrician with decades of experience in various medical facilities both in Pakistan and Saudi Arabia. She has headed the Department of Preventive Pediatrics at the prestigious, Children’s Hospital and Institute of Child Health in Pakistan and is a life member of the Pakistan Paediatric Association. She has also completed her Post Graduate Program... more

Dr. Ritika Shah

Dr. Ritika Shah is a dental surgeon with more than seven years of clinical experience across various cities in India. During her clinical practice, pediatric dentistry was her particular area of interest, and she constantly thrived to inculcate the latest advancements in the field of dentistry into her practice. She also holds a certificate in lactation counselling from iNational Health... more

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