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A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia.

Apnea of prematurity

Apnea - newborns; AOP; As and Bs; Blue spell - newborns; Dusky spell - newborns; Spell - newborns

Last reviewed: December 4, 2013.

Apnea is breathing that slows down or stops from any cause. Apnea of prematurity refers to short episodes of stopped breathing in babies who were born before they were due.

Causes

There are several reasons why newborns, in particular those who were born early, may have apnea, including:

  • Their brain is not fully developed
  • The muscles that keep the airway open are weak

Other stresses in a sick or premature baby may worsen apnea, including:

Symptoms

Newborns, especially preemies, often have an irregular breathing pattern.

These babies will have short episodes (5 - 10 seconds) of either shallow breathing or stopped breathing (apnea). These episodes are followed by periods of normal breathing.

When there is very shallow or no breathing (apnea), the baby may also have a drop in heart rate. This heart rate drop is called bradycardia.

Some babies may also have poor color and an ill-looking appearance. Apnea episodes that last longer than 20 seconds are considered serious.

Exams and Tests

Most preterm and some sick full-term babies have some degree of apnea so, these babies are hooked up to monitors in the hospital. The monitors keep track of their breathing, heart rate, and oxygen levels. Apnea or a drop in heart rate can set off the alarms on these monitors.

Treatment

How apnea is treated depends on the cause, how often the breathing stops, and the severity of spells. Babies who appear to be otherwise healthy and have few spells per day are simply watched. They can be gently stimulated during periods when breathing stops.

Babies who are well, but who have many episodes in which they stop breathing, may be given a caffeine preparation to help stimulate their breathing. Sometimes the nurse will suction children with apnea, change their position, or use a bag and mask to help them breathe.

Proper positioning, slower feeding time, oxygen, and (in extreme cases) a breathing machine may be needed to assist in breathing.

Studies have not been able to show a benefit to putting babies on home monitors, so these monitors are not used very often anymore.

Outlook (Prognosis)

Apnea is common in premature babies. Most babies have normal outcomes. Although mild apnea is not thought to have long-term effects. However, most doctors feel that preventing multiple or severe episodes is better for the baby over the long-term.

Apnea episodes that began after the second week of life or that last longer than 20 seconds are considered more serious.

Apnea of prematurity usually goes away by the baby's 36th week.

References

  1. Miller MJ, Martin MJ. Pathophysiology of apnea of prematurity. In: Polin RA, Fox WW, Abman SH. eds. Fetal and Neonatal Physiology. 4th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 91.
  2. Carlo WA. Apnea. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 95.2.

Review Date: 12/4/2013.

Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

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Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for apnea of prematurityNasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for apnea of prematurity
    Nasal intermittent positive pressure ventilation (NIPPV) is a potentially beneficial treatment for apnea in premature babies, but more research is needed to confirm the effectiveness and safety of this intervention. Recurrent spells of apnea (pause in breathing greater than 20 seconds) are almost universal in babies born before 34 weeks gestation. Nasal continuous positive airway pressure (NCPAP) delivered via small prongs inserted in the baby's nose offers breathing support and is a useful treatment for apnea. However, not all babies respond to this treatment. Some infants fail and require a breathing tube inserted into their trachea (windpipe), which has potential complications (infection, injuries to the vocal cords). This review of two small trials suggests that nasal intermittent positive pressure ventilation (NIPPV) delivered via nasal prongs may be more effective than NCPAP alone in preterm babies whose apneas are frequent or severe. Further research is needed to confirm effectiveness and safety as few babies have been studied so far.
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