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Apnea of Prematurity

What is apnea?

Apnea is a pause in breathing that lasts more than 15 to 20 seconds. 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 the baby is able to start breathing again. Babies whose apnea lasts a long time do not have more problems than other babies. 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 baby needs to breathe regularly to get oxygen. The brain controls breathing. The premature baby's brain is not yet set up for regular breathing.

Babies can have apnea as a result of a seizure, an infection like meningitis, or an injury like a shaken baby. Premature babies will outgrow AOP as the brain matures.

What are the symptoms?

A baby with apnea:

  • Stops breathing for more than 15 to 20 seconds
  • May have a heartbeat below 80 beats a minute when the apnea happens
  • Gets pale or bluish during an apnea spell

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

How is it diagnosed?

Your baby may have tests such as:

  • Blood tests
  • An EEG, which measures and records the electrical activity in the brain
  • Tests to measure how well the red blood cells carry oxygen
  • X-rays

How is it treated?

The treatment for apnea is to help the baby breathe until he outgrows the problem. If apnea is caused by a seizure, infection, or bleeding in the brain, treating those problems helps treat apnea.

Monitoring and Stimulation

Premature and sick newborn babies are attached to a monitor that constantly measures heart rate and breathing rate. If the baby stops breathing for too long or his heart rate drops too low, the monitor sounds an alarm.

When the monitor alarm sounds, a nurse checks the baby. Many times the baby starts breathing again by herself and does not need any help.

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


Medicine can cause the part of the brain that controls breathing to be more active. This can reduce the number of apnea spells. It can be given directly into the vein (IV) or mixed in with milk during feedings. The baby keeps getting medicine until he has outgrown the apnea.

Breathing machines

If apnea spells happen a lot or last a long time and the baby needs help to start breathing again, the baby may need a breathing machine for a few days or weeks. Nasal CPAP and a ventilator are two kinds of machines that can help babies breathe.

  • Nasal CPAP gently blows oxygen under pressure through the nose into the baby's airway and lungs. The baby doesn't work as hard to breathe, because the pressure from the CPAP machine helps keep the airway open.
  • Ventilators blow air and oxygen under pressure through a tube that goes in the baby’s mouth or nose, down the windpipe, and into the lungs. After a few days or weeks the baby is taken off the ventilator to see if she is ready to breathe on her own.

Using breathing machines does not cause the baby to get lazy or forget how to breathe. The machines give babies time to mature and grow.

Treating other problems

Infection, low red blood cell counts, low body temperature, 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. The baby may still need medicines or home monitoring. You will be taught how to use the monitor if one is sent home with you.

It’s also a good idea for your family to learn infant cardiopulmonary resuscitation (CPR) before the baby goes home. Even if you never use CPR, it is best to be prepared.

Developed by RelayHealth.
Pediatric Advisor 2013.2 published by RelayHealth.
Last modified: 2012-07-25
Last reviewed: 2012-04-16
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
© 2013 RelayHealth and/or its affiliates. All rights reserved.
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