Apnea of Prematurity

What is Apnea of Prematurity

Apnea of prematurity is a condition in which infants who are born early (prematurely) stop breathing temporarily during sleep. There are three types of apnea of prematurity:

  • Obstructive sleep apnea of prematurity. This type is caused by a blocked or collapsed airway.
  • Central sleep apnea of prematurity. This type happens when the part of the brain that controls breathing does not send the correct signals to the muscles that control breathing. The more premature the baby is, the less well the brain controls breathing.
  • Mixed sleep apnea of prematurity. This is a combination of central and obstructive apnea.

Apnea of prematurity is a common condition among premature infants. The condition gets better as the baby grows, and often goes away about 37 weeks after the pregnancy started (conception). Once it is gone, it does not come back.

What are the causes?

This condition may be caused by:

  • Lack of development in the part of the brain stem that controls breathing.
  • Blockage or collapse of the airway, which may result from:
    • Weak muscles that surround the airway.
    • The neck bending forward.
    • Too much mucus or milk in the air passages.

What are the signs or symptoms?

Apnea episodes may happen starting one day after birth and may last for up to 3 months after birth. During an apnea episode:

  • Breathing stops or pauses for 15–20 seconds. It may not start again without help.
  • The heart rate slows.
  • The blood oxygen level lowers, which may cause the baby’s skin to become pale or blue.
  • The baby may become limp.

The frequency and severity of apnea episodes vary. The more premature an infant is, the more frequent and severe the symptoms.

The following may trigger or worsen apnea episodes:

  • Infection.
  • Low red blood cell or hemoglobin count (anemia).
  • Imbalance of body minerals (electrolytes).
  • Low oxygen levels.
  • Low body temperature.

How is this diagnosed?

This condition is diagnosed by:

  • Monitoring episodes of apnea and your baby’s symptoms. This may be done by monitoring the heart rate, breathing rate, and oxygen level of your baby.
  • Ruling out other potential causes of the apnea. Your baby may have tests to rule out other possible causes, such as anemia or infection.

How is this treated?

This condition is managed in the hospital, where your baby will be monitored. Treatment varies depending on the cause, frequency, and severity of symptoms, and may include:

  • Placing your baby in a warmer (incubator) to help maintain body temperature.
  • Oxygen therapy, if needed. This may be done using:
    • A device that delivers oxygen through a tube in the nose. This may be a nasal continuous positive airway pressure (CPAP) or a high or low flow nasal cannula.
    • A machine to help your baby breathe (respirator). This involves placing a tube in your baby’s windpipe (trachea) or nose.
  • Monitoring your baby’s breathing and heart rate. If the monitor detects a problem, it will set off an alarm. If the alarm goes off, your baby will be checked and one or more of the following actions may be taken:
    • Your baby may be watched to see if he or she starts breathing again.
    • The position of your baby may be adjusted.
    • Mucus may be removed from your baby’s nose through suction.
    • Your baby’s skin may be gently rubbed.
    • Your baby may be given a few breaths of oxygen from a bag and mask.
  • Medicines that stimulate the part of the brain that controls breathing.

If your baby has problems that trigger or worsen apnea, those problems will also be treated. Depending on your baby’s condition, your baby may receive:

  • Antibiotic medicines to treat infection.
  • Donated blood (blood transfusion) to treat anemia. This is given through an IV.
  • Body minerals to establish a normal balance of minerals in the body. This is given through an IV.

It is important to spend time with your infant including regular skin to skin contact. Ask your health care team how you can feed, hold, and bond with your baby while he or she is in the hospital.

If your baby is sent home before the apnea goes away, you will be sent home with a machine that is used to monitor his or her heartbeat and breathing (home apnea monitor). This machine sounds an alarm if there is a problem. You will be taught how to use the monitor and how to respond to an alarm.

Follow these instructions at home:

If your baby has a home apnea monitor:

  • Use the monitor as directed by your baby’s health care provider.
  • Some minor skin irritation from the device is normal. Ask your baby’s health care provider how to best care for your baby’s skin.
  • Keep important phone numbers handy in case you have questions or concerns. These include:
    • Emergency numbers.
    • Your health care provider’s number.
    • The apnea monitor company’s number.
  • Make sure anyone caring for your baby is trained in infant CPR and home apnea monitoring.
  • Home apnea monitoring can be stressful. Discussing your concerns with your baby’s health care provider or talking with parents who have used an apnea monitor before may help relieve some of your stress.

General instructions

  • Give your baby over-the-counter and prescription medicines only as told by his or her health care provider.
  • If your baby was prescribed an antibiotic medicine, give it to your baby as told by your health care provider. Do not stop giving the antibiotic even if your baby’s condition starts to improve.
  • If your baby is not breathing or your baby’s face seems pale or blue, follow the instructions given to you to help stimulate normal breathing. Do not shake your baby to wake him or her. If you follow instructions to stimulate breathing and your baby is still not breathing normally:
    • Start CPR.
    • Call your local emergency services (911 in the U.S.).
  • Keep all follow-up visits as told by your baby’s health care provider. This is important.

Contact a health care provider if:

  • You have any questions or concerns about home monitoring.
  • You need help coping with the stress of home monitoring.

Get help right away if:

  • You are not able to stimulate your baby’s breathing.
  • Your baby is pale or bluish in color and is not breathing.
  • You have started CPR.
  • Your baby has a temperature of 100.4°F (38°C) or higher.

If any of these things happen, call your local emergency services (911 in the U.S.). Then start or continue to give your baby CPR.

Summary

  • Apnea of prematurity is a condition in which infants who are born early (premature infants) stop breathing temporarily during sleep. The episode usually last 15–20 seconds.
  • This condition may be caused by a lack of development in the part of the brain stem that controls breathing. It may also be caused by a blockage of the baby’s airway.
  • The more premature an infant is, the more likely he or she is to have symptoms, and the more often and severe the apnea episodes.
  • During an apnea episode, a baby’s heart rate drops, the baby may become limp, and the baby may turn pale or blue.
  • Apnea of prematurity gets better as the baby’s body matures. The condition often goes away at about 37 weeks after conception. Once it is gone, it does not come back.
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