BSC YR 3

PRESENTER- TABITHA MAINA

APNEA OF PREMATURITY
DEFINATION
• Apnea of prematurity refers to the cessation of breathing for <20
seconds or shorter pauses accompanied by desaturation and
bradycardia.
INCIDENCE
• Apnea of prematurity varies inversely with gestational age
• Nearly 100% in infants born< 28weeks
• 85% in infants born at 30 weeks
• 20% in infants born at 34 weeks
• The onset of idiopathic apnea can be during the 1st 1-2 week after
birth but is often delayed if there is RDS or other causes of respiratory
distress.
ETIOLOGY
• Apnea is a disorder of the respiratory control and may be
Obstructive(10%)- Upper airway obstruction e. g, neck flexion,
characterized by absence of airflow but persistent chest wall motion.
Central( 40%)- due to immaturity of respiratory centers; both airflow
and chest wall motion are absent.
- It is caused by decreased central nervous system (CNS) stimuli to
respiratory muscles
Mixed(50-75% of the cases), with obstructive apnea preceding
(usually) or following central apnea.
- Short episodes of apnea are usually central, whereas prolonged ones
are often mixed
 Etiology contd;
• The following systemic causes produce apnea by;
a) Direct depression of the central nervous system’s control of respiration
-Drugs such as sedatives and prostaglandins
-Seizures
-Hypoglycemia
-Intraventricular hemorrhage
-Meningitis
b) Disturbance in oxygen delivery
-Shock
-Sepsis
-Anemia
 Etiology contd;
c) Ventilation defects such as obstruction of the airway, pneumonia, muscle
weakness and disorders e. g, RDS, Patent ductus arteriosus(PDA),NEC , Pierre Robin
sequence
- Idiopathic apnea of prematurity may occur in the absence of identifiable
predisposing factors.
- frequency of apnea also increases with active REM sleep.
CLINICAL MANIFESTATION

• Bradycardia- a significant drop in heart rate follows the apnea by 1-2

sec in more than 95% of cases
• Cyanosis- bluish discoloration of the skin due to decreased
oxygenation.
• Decreased oxygen saturation levels.
• Pallor in the case of anemia or IVH.
• Temperature- hypothermia or hyperthermia as in sepsis or infections.
MANAGEMENT
• Investigate and treat any possible underlying cause e.g.
- Full sepsis screen and start broad spectrum antibiotics
- GORD: ensure correct NG tube position, positioning the baby with head up tilt, prone or lateral, reduce
feed volume and increase frequency, feed thickener and anti GOR medications
• Cardio respiratory monitoring
• Apnea chart to document frequency and severity of apnea.
• Interventions for apnea with bradycardia and desaturations:
 Tactile stimulation
 Supplemental oxygen
 Gentile oral suction
 Positioning: to avoid extreme flexion or extension of the neck
 Respiratory stimulants: started in the 1st few days of life for those <30 wks
- Aminophylline
- Caffeine citrate
 BiPAP(Biphasic Positive Airway Pressure) or SiPAP(Synchronized Positive Airway Pressure)
 Mechanical ventilation if drugs fail
PROGNOSIS
• Apnea of prematurity usually resolves by week 37 of postconceptional
age, although it may persist beyond term gestation, particularly in
extremely preterm infants born at <28 weeks of gestation.
• Some infants with persistent apnea are discharged with
cardiorespiratory monitoring performed at home.
• In the absence of significant events, home monitoring can be safely
discontinued after 44 weeks postconceptional age.