Apnea of Prematurity
Apnea of prematurity is defined as a brief pause in breathing occurring in premature infants, usually lasting for over 20 seconds.
- Episodes of apnea usually occur when the respiratory center in the infant’s brain has not become sufficiently mature due to prematurity.
- Apnea often results in a bluish discoloration of the skin in the infant due to the poor oxygen content in the blood; it may slow down the heart rate too.
- Apnea may be detected on close observation of the infant, or when alerted by a monitor with an alarm attached to the infant.
- Episodes of apnea occur less frequently as the infant’s respiratory center in the brain gradually becomes mature, finally stopping completely.
- When the infant having an episode of apnea does not start breathing when prodded gently, artificial respiration should be given immediately.
- Caffeine is given to infants with severe apnea to stimulate their breathing.
Premature infants, especially those who are born prior to completing 34 weeks of gestation, are prone to apnea of prematurity. The severity, as well as the frequency, of the episodes is dependent on the gestational age of the premature infant. The respiratory center in the infant’s brain which controls breathing may not have become fully developed to regulate the breathing. Due to this, the infant may have intermittent periods of regular breathing punctuated by short pauses, during which the oxygen levels of the blood may get significantly lowered. Apnea in premature infants may be the result of an obstruction of the pharynx too. Obstructive apnea is more common in extremely premature infants, and it occurs due to their poor muscle tone, or because of the neck bending forward and creating a temporary block.
Gradually, as the muscle tone of the infant improves, and the respiratory center in the brain becomes mature, the severity, as well as the frequency, of the episodes will reduce, till they stop completely.
Symptoms and Diagnosis
When infants are born prematurely, they are monitored closely to detect any signs of distress which may require immediate medical attention. They are placed on an apnea monitor which beeps an alarm whenever the breathing of the infant pauses for over 20 seconds. Low heart rate also triggers the alarm. When the episodes of apnea are longer, it may result in low levels of oxygen in the infant’s blood. The infant may have bluish skin and lips, a condition termed cyanosis. Low oxygenation of blood often leads to bradycardia or the slowing down of the heart also.
Apnea in premature infants most commonly occur due to the immaturity of their brain. However, in some cases, it may be the symptom of other disorders like hypoglycemia, which is an abnormally low level of blood glucose. An infection of the blood termed sepsis can also lead to apnea. Hypothermia, or abnormally low body temperature, is another condition in premature infants that may cause apnea. When the episodes of apnea suddenly increase in an infant, doctors investigate all possible reasons for the condition. Samples of urine, blood and cerebrospinal fluid are collected and tested for infections. The blood glucose levels are also tested to detect hypoglycemia.
Treatment
When pauses in breathing are observed either directly, or with the help of the alarm sounded by the apnea monitor, a gentle prod or touch will usually restore normal breathing in the infant. Depending on what caused the apnea, different treatments are given. If an obstruction of the infant’s pharynx is causing the apnea, keeping the infant on its back, with the head positioned centrally with supports, usually help reduce the occurrence. Making the infant lie on its side, with adequate support to the head, also helps.
The stimulating effect of caffeine is used to activate the respiratory center of the brain, if episodes of apnea occur very frequently. Drug treatment with stimulants like coffee is often given to infants who are prone to developing cyanosis with the episodes of apnea. If drug therapy does not yield the desired results, and severe apnea continues to occur frequently, a technique called continuous positive airway pressure or CPAP may be used. Oxygen under slight pressure is delivered to the infants via nose prongs to assist their normal breathing. In very severe cases, ventilator support may be inevitable.
Almost all the premature infants who have episodes of apnea due to prematurity eventually stop having them, even weeks before they complete full term.
Sudden infant death syndrome, or SIDS for short, is more common in premature babies, but there is no direct relation between apnea of prematurity and the risk of sudden infant death later on. Babies who have apnea of prematurity are often discharged from the hospital with an apnea monitor, to detect pauses in the breathing and to alert the parents when they occur. However, the risk of death from SIDS is not in any way reduced by the use of an apnea monitor.
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Yasser Elnahas
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