Apnea of Prematurity

In the hospital, premature newborns are routinely attached to a monitor that sounds an alarm if they stop breathing for 20 seconds or more or if their heart rate slows. Depending on the length of the episodes, pauses in breathing may decrease the oxygen levels in the blood, which results in a bluish discoloration of the skin and/or lips (cyanosis Cyanosis Cyanosis is a bluish discoloration of the skin resulting from an inadequate amount of oxygen in the blood. Cyanosis occurs when oxygen-depleted (deoxygenated) blood, which is bluish rather than... read more ) or pale skin (pallor). Low levels of oxygen in the blood may then slow the heart rate (bradycardia).

The diagnosis of apnea is usually made by observing the newborn breathe or by hearing the alarm of a monitor attached to the newborn and noting no breathing movements when the newborn is checked.

Apnea can sometimes be a sign of a disorder, such as infection in the blood (sepsis Sepsis in Newborns Sepsis is a serious bodywide reaction to infection spread through the blood. Newborns with sepsis appear generally ill—they are listless, do not feed well, often have a gray color, and may have... read more ), low blood sugar (hypoglycemia Hypoglycemia Diabetes mellitus is a disorder in which blood sugar (glucose) levels are abnormally high because the body does not produce enough insulin or fails to respond normally to the insulin produced... read more ), or a low body temperature (hypothermia Hypothermia Hypothermia (dangerously low body temperature) is often regarded as a cold injury, because it can be caused or made worse by exposure to cold surroundings. Being in an environment that is too... read more ). Therefore, doctors evaluate the newborn to rule out these causes when apnea begins suddenly or unexpectedly or the frequency of apnea episodes increases. Doctors may take samples of blood, urine, and cerebrospinal fluid to test for serious infections and test blood samples to determine whether the level of blood sugar is too low.

Over time, as the respiratory center matures, episodes of apnea become less frequent, and by the time the newborn approaches 37 weeks of gestation Gestational age Problems in newborns may develop Before birth while the fetus is growing During labor and delivery After birth About 9% of newborns need special care after birth due to prematurity, problems... read more , the episodes usually no longer occur. Apnea may continue for weeks in infants who were born extremely prematurely (such as at 23 to 27 weeks). Apnea of prematurity rarely causes death.

Although premature birth is a risk factor for sudden infant death syndrome Sudden Infant Death Syndrome (SIDS) Sudden infant death syndrome is the sudden, unexpected death, usually during sleep, of a seemingly healthy infant between 1 month and 1 year of age. The cause of sudden infant death syndrome... read more (SIDS), an association between apnea of prematurity and a later risk of SIDS has not been proved. Likewise, there is no proof that discharging a premature newborn from the hospital with an apnea monitor decreases the risk of SIDS.

When apnea is noticed, either by observation or monitor alarm, newborns are touched or prodded gently to stimulate breathing, which may be all that is required.

Further treatment of apnea depends on the cause. Doctors treat known causes such as infections.

If episodes of apnea become frequent, and especially if newborns have cyanosis, they remain in the neonatal intensive care unit Neonatal intensive care unit (NICU) Problems in newborns may develop Before birth while the fetus is growing During labor and delivery After birth About 9% of newborns need special care after birth due to prematurity, problems... read more (NICU). They may be treated with a drug that stimulates the respiratory center, such as caffeine. If this treatment does not prevent frequent and severe episodes of apnea, newborns may need treatment with continuous positive airway pressure Obstructive sleep apnea (CPAP). This technique allows newborns to breathe on their own while receiving slightly pressurized oxygen or air given through prongs placed in the nostrils. Newborns who have apnea spells that are difficult to treat may need a ventilator Mechanical Ventilation Mechanical ventilation is use of a machine to aid the movement of air into and out of the lungs. Some people with respiratory failure need a mechanical ventilator (a machine that helps air get... read more (a machine that helps air get in and out of the lungs) to help them breathe.