Apnea

Overview

Apnea is a condition in which a baby periodically stops breathing for more than 15 to 20 seconds. Premature infants, particularly those born more than seven weeks early, may suffer from apnea from time to time.

While in the womb, babies receive oxygen from the mother's placenta. Once born, they need to breathe on their own. Some premature babies can't breathe normally when first born because their brains aren't yet programmed to sustain nonstop breathing. This is called central apnea.

Premature babies can also suffer from obstructive apnea, which occurs when their small airways become blocked. This may be caused by mucus, or the baby may be in a position that kinks the airway.

Apnea is associated with another condition, called bradycardia. This is a slowing of the heart rate, usually to less than 80 beats per minute for a premature baby. Bradycardia often follows apnea or periods of very shallow breathing.

Signs & symptoms

Babies experiencing apnea will:

• Suddenly stop breathing for more than 15 to 20 seconds
• Become pale or bluish around the mouth and face
• Start breathing again on their own, or need help to restart breathing

Babies may also experience bradycardia, a condition in which a baby's heart rate drops to below 80 beats per minute. This usually occurs after a period of apnea.

Diagnosis

The doctor will begin by conducting a physical examination of your baby to try and determine if the apnea is due to the premature birth or another problem.

Tests used to make a definite diagnosis may include:

• Apnea study, which monitors your baby's breathing effort, heart rate and oxygenation
• Blood tests to check your baby's blood counts and electrolyte levels for any signs of infection
• Measurement of the oxygen levels in your baby's blood
• X-rays to check for problems in the lungs, heart and digestive system

Treatment

Because most premature babies have apnea, they're sent to the Intensive Care Nursery where they're attached to a monitor called a cardiorespiratory monitor. An alarm sounds if the monitor detects that your baby stops breathing for too long or if his or her heart rate drops. If the alarm sounds, a nurse immediately checks your baby for signs of apnea. False alarms are not uncommon.

If your baby does experience apnea and isn't breathing, a nurse will rub your baby's back, arms and legs to try to stimulate breathing. Your baby's head may also be turned or your baby may be placed on his or her stomach or back. If this stimulation does not work, a bag filled with oxygen will be placed over your baby's mouth. This is called mask-and-bag breathing.

In addition to monitoring, babies with apnea may also be treated with medications and respiratory support.

Medications

Several medications can help reduce spells of apnea by stimulating the part of your baby's brain that controls breathing. Aminophylline and theophylline are the most commonly used drugs. Caffeine may also be used.

Respiratory Support

Respiratory support may be used to help your baby start breathing again.

• Continuous positive airway pressure (CPAP): Developed in 1969 at UCSF Benioff Children's Hospital by Dr. George Gregory, CPAP is a method for keeping a continuous positive pressure on the lung gases so that when a baby breathes out, the lung chambers will remain inflated. During this procedure, oxygen is delivered through little tubes that fit into your baby's nostrils.
• Ventilator: Babies who suffer from severe, frequent spells of apnea may be put on a ventilator to help them breathe. A tube is placed through your baby's mouth into the windpipe. The ventilator blows air and oxygen through the tube and into the lungs.