Apnea of Prematurity

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KEY POINTS

• Apnea normally means that breathing has stopped. With apnea of prematurity, a baby’s breathing usually slows down gradually, stops briefly, and then slowly returns to a normal rate.
• The treatment for apnea of prematurity is to help the baby breathe until the baby outgrows the problem. Your baby may need monitors, medicines, or breathing machines.
• Your baby may need home monitoring. You will be taught what to do if your baby has apnea spells. Follow the full course of treatment prescribed by your child’s healthcare provider.

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What is apnea?

Apnea normally means that breathing has stopped. With apnea of prematurity, a baby’s breathing usually slows down gradually, stops briefly, and then slowly returns to a normal rate. However, apnea can also happen suddenly. Babies who are born earlier than 35 weeks of pregnancy often have apnea. Babies outgrow apnea of prematurity (AOP), usually by 1 month after their due date.

AOP does not cause long-term brain damage as long as your baby is able to start breathing again. Apnea that begins after the second week of life or lasts longer than 20 seconds is more serious. AOP does not cause SIDS (sudden infant death syndrome, or crib death).

What is the cause?

Before birth, a baby gets oxygen from the mother’s blood. Once born, the brain tells the body to breathe regularly to get oxygen. A premature baby's brain may not yet be fully developed. As the baby gets older, the brain matures and the breathing problem usually goes away. Also, premature baby’s airway muscles may not be strong enough to keep the airway open and makes it harder for the baby to breathe.

Apnea in premature babies can also be made worse by an infection, lung or heart problems, feeding problems, or not enough red blood cells in the blood.

What are the symptoms?

Symptoms may include:

• Slowdown in breathing or stopping breathing for 20 seconds
• Having a heartbeat below 80 beats a minute when the baby slows or stops breathing for less than 20 seconds
• Getting a pale or bluish skin color during an apnea spell

It may be hard for a premature baby to suck, swallow, and breathe all at the same time.

Apnea may happen once a day or many times a day. The more premature the baby is, the more likely the baby will have apnea spells.

How is it diagnosed?

Your baby may have tests such as:

• Blood tests
• Monitoring the baby’s heart rate, brain waves, chest movement, and blood oxygen levels
• X-rays

How is it treated?

The treatment for apnea of prematurity is to help your baby breathe until he or she outgrows the problem.

Monitoring

In the hospital, your baby will be attached to a monitor that constantly measures heart rate and breathing rate. If your baby stops breathing for too long or if the heart rate drops too low, the monitor sounds an alarm. Many times your baby starts just breathing again and does not need any help.

If your baby is not breathing, a nurse will gently rub your baby’s back, arms, or legs. The nurse may turn your baby’s head to a different side or turn your baby over. If your baby is still pale or bluish, your baby may be given oxygen.

Medicines

Medicine can help the part of the brain that controls breathing to be more active. This can reduce the number of apnea spells. Your baby may keep getting medicine until he or she has outgrown the apnea.

Breathing machines

If apnea spells happen often or last a long time and your baby needs help to start breathing again, your baby may need a machine that uses a soft plastic tube to blow air into the nose that helps remind your baby to breathe. If this does not help, your baby may need a breathing machine for a few days or weeks.

Treating other problems

Infection, low red blood cell counts, low body temperature, low blood glucose, or bleeding in the brain can make apnea worse. If your baby has any of these problems, they will also be treated.

How can I take care of my child?

Usually, babies who have no apnea spells for 5 to 7 days can go home. Your baby may still need medicines or home monitoring. You will be taught what to do if your baby has apnea spells. Usually, all that is needed is gentle stimulation. But it’s also a good idea for your family to learn infant cardiopulmonary resuscitation (CPR) before your baby goes home. Even if you never use CPR, it is best to be prepared.

Do not give your baby any medicines unless your baby’s healthcare provider tells you to do so. Follow the full course of treatment prescribed by your baby’s healthcare provider.

Ask your provider:

• How and when you will get your baby’s test results
• How long it will take your baby to recover
• How to take care of your baby at home
• What symptoms or problems you should watch for and what to do if your baby has them

Make sure you know when your baby should come back for a checkup. Keep all appointments for provider visits or tests.