Apnea of Prematurity

Apnea is a stop in breathing. Apnea of prematurity is a condition in which infants who are born early (premature infants) have apnea episodes associated with a decrease in oxygenation or heart rate. Apnea of prematurity is a common condition in premature infants. There are three types of apnea of prematurity:

  • Central. This type is due to lack of maturity in the part of the brain that controls breathing. The baby's brain does not tell the body to breathe. The more premature the infant is, the less well the brain controls breathing.

  • Obstructive. This type is due to a blockage of air passages. The baby's brain tells the body to breathe in, but the breaths are not effective. Premature babies have very small air passages that are not as strong as those of older babies. Air passages can get blocked if:  

  • Your infant has too much mucus.  

  • They collapse on themselves.  

  • Mixed. Babies with mixed apnea have a combination of central and obstructive apnea.

SYMPTOMS

Apnea episodes start after the first day of life and before the end of the first week of life. The more premature an infant is, the more likely he or she is to experience symptoms and the more often and severe the apnea episodes. During an episode:

  • The baby's breathing stops or pauses. It may not start again without help.  

  • The baby's heart rate drops.  

  • The baby may turn pale or blue.  

  • The baby may become limp.  

DIAGNOSIS

Apnea of prematurity is diagnosed by:

  • Observing the episodes of apnea and symptoms.

  • Eliminating other potential causes of the apnea.

TREATMENT

  • Your baby will be treated in the nursery at the hospital.

  • A number of things will be done to help prevent your baby from having apnea episodes.

  • Your baby will likely be placed in an incubator or warmer to help maintain body temperature because low temperatures may lead to apnea. Your baby will be placed in the warmer in a way that helps keep his or her airway open.

  • Your baby may receive supplemental oxygen if it is needed.

  • Your baby's health care provider will rule out other causes of apnea such as infection.

  • A monitor will measure your baby's breathing and heart rate, and an alarm will go off when the device detects possible problems. If the alarm goes off, depending on how the baby looks, a nurse may:

  • Check to see if the baby is breathing and how he or she looks.  

  • Check the device.  

  • Watch to see if the baby's breathing starts again on its own.  

  • Change the baby's position.  

  • Suction mucus from the nose.  

  • Gently rub the baby's skin.  

  • Give a few breaths of oxygen or air from a bag and mask.

If the apnea spells are severe or frequent, other treatments may be done. Additional treatment may involve:

  • Medicines that stimulate the part of the brain that controls breathing.  

  • Nasal continuous positive airway pressure (CPAP). This involves giving air or oxygen under gentle pressure through a tube in the nose to:  

  • Keep the air passages open.  

  • Make breathing easier.  

  • A respirator. This is a machine that helps with breathing. In this treatment, a tube is placed in the baby's windpipe or in the baby's nose.  

Any other problems that can cause apnea may also be treated with:

  • Antibiotic medicines (for infection).  

  • Blood transfusions (for anemia).  

  • Treatment of body minerals being out of balance.  

 Apnea of prematurity gets better as the baby's body matures. The condition often goes away about 37 weeks after the pregnancy started (conception). Once it is gone, it does not come back.

HOME CARE INSTRUCTIONS

  • You and everyone that cares for your child should be trained in infant CPR.  

  • If your baby is not breathing or your baby's face seems pale or blue, follow the instructions given to you. Usually, your response will involve gentle stimulation techniques. If these do not work, start CPR and call your local emergency services (911 in the U.S.). Do not shake your baby to wake him or her. 

Home Apnea Monitor 

Apnea of prematurity usually goes away before babies are sent home, but in some cases babies are sent home before their apnea has gone away. These babies are sent home with a home apnea monitor. A home apnea monitor measures heart rate and breathing rate and sets off an alarm if it detects a problem. Home apnea monitors are not perfect safeguards. Sometimes they fail to set off an alarm if there is a problem (this may happen if the monitor is not correctly connected to the baby). Home apnea monitors can store readings that can be downloaded to a computer. Your baby's health care provider can analyze these readings later. Before you leave the hospital, you will be taught how to use the monitor and you will learn how to respond to an alarm. Make sure you understand your health care provider's instructions and ask questions if you have them. Your baby's health care provider will determine how long your baby will wear the monitor.

SEEK MEDICAL CARE IF:

  • You have any questions or concerns about home monitoring.  

  • You or your family need help coping with the stress of home monitoring.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Your baby does not respond to stimulation techniques and is blue.  

  • You have started CPR.  

If any of these things happen, call your local emergency services (911 in the U.S.).