Definition

Apnea of prematurity is a temporary stop in breathing in infants. It lasts at least 15-20 seconds, or less than 15 seconds with a slowed heart rhythm or other symptoms. It is most common in premature infants but can rarely occur in full term infants as well. A slowed heart rhythm called bradycardia can also occur with the apnea.

Causes

Apnea may be caused by problems with the nervous system, weak muscles in the airway, or a combination of both.

Breathing is controlled by the brain. The brain should both sense the need for increased breathing and stimulate the body to breathe. Immature nervous systems, like those in premature infants, may not be able to do these functions. This type of apnea is known as central apnea.

Premature infants may also have weak muscles around the airway. The muscles cannot properly support the airway and keep it open, making breathing difficult. This type of apnea is known as obstructive apnea.

Certain medications, such as narcotics, prostaglandin, and magnesium sulfate, can also suppress the body’s urge to breathe.

Risk Factors

Risk factors of apnea of prematurity may include:

• Birth before 35 weeks of pregnancy the earlier the birth, the greater the risk
• Receiving certain medications

Factors that may worsen the apnea include:

• Heart or lung problems
• Low oxygen in the blood (hypoxemia)
• Feeding difficulty
• Temperature control problems
• Infections
• Overstimulation

Symptoms

Symptoms occur in the first week of life. Symptoms may include:

• Very shallow breathing
• Long pauses between breaths
• Bluish skin color

Diagnosis

Breathing and heart rates are monitored in most premature babies for at least the first few days.

At the initial onset of apnea:

• Your baby will be examined closely.
• Your baby’s bodily fluids may be tested. This can be done with blood tests.
• Images may be taken of your baby’s chest or head. This can be done with an X-ray or ultrasound.

Treatment

Apnea of prematurity will go away on its own as the infant approaches what would have been the 36th week of gestation.

Treatment may be needed until the apnea resolves. Options will depend on how frequent and severe the apnea episodes are and the infant’s overall health. Most premature infants will be hospitalized during the time that apnea is present. Part of care will include heart rate and breathing monitoring. The monitors will sound an alarm when abnormal breathing is present.

Rubbing or patting the baby during an episode can stimulate breathing to start again. Infants with mild and infrequent episodes can simply be monitored and stimulated when needed. More frequent episodes may require:

Prevention

There is no known way to prevent apnea of prematurity. Since the apnea is related to prematurity, decreasing the risk of premature birth may help. Some cases of premature birth may be prevented with proper prenatal care and good health of the mother during pregnancy. General tips for a healthy pregnancy include:

• Get good prenatal care. Start as early as possible in pregnancy.
• Eat a healthful diet and take recommended vitamins.
• Avoid smoking, drinking alcohol, and taking drugs.
• Only take medications that your doctor has approved.
• Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs) or selective serotonin reuptake inhibitors (SSRIs). Talk to your doctor about alternatives that may be safer.

Kids Health—Nemours Foundation http://kidshealth.org

Canadian Paediatric Society http://www.cps.ca

Apnea of prematurity. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated August 12, 2014. Accessed March 19, 2015.

Apnea of prematurity. Johns Hopkins Children’s Center website. Available at: https://hopkinschildrens.org/apnea-of-prematurity.aspx. Accessed March 19, 2015.

Apnea of prematurity. Kids Health—Nemours Foundation website. Available at:
http://kidshealth.org/parent/medical/lungs/aop.html#a_Treatment
Updated October 2014. Accessed March 19, 2015.

Apnea of prematurity. University of Rochester Medical Center website. Available at:
http://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02922
Accessed March 19, 2015.