Apnoea Flashcards
What is apnea in preterm infants?
Apnea in preterm infants refers to a pause in breathing lasting over 20 seconds, leading to hypoxia, bradycardia, and cyanosis or pallor.
Why is apnea more common in preterm infants?
Apnea is more common in preterm infants due to immature respiratory control, resulting in impaired respiratory drive (central cause) or inability to maintain upper airway patency (obstructive cause).
What are the different types of apnea in preterm infants?
Apnea in preterm infants can have both central and obstructive elements, known as mixed apnea. It may lead to severe complications like brain damage or death if recurrent
What is periodic breathing, and how does it differ from apnea in preterm infants?
Periodic breathing refers to recurrent short periods of interrupted respiration without cyanosis and bradycardia, unlike apnea in preterm infants, which involves prolonged pauses in breathing leading to hypoxia and bradycardia.
Causes of apnea
- Immaturity.
- Respiratory distress or hypoxia.
- Aspiration of a feed or nasopharyngeal suctioning.
- Infection (especially meningitis or septicaemia).
- Hypoglycaemia.
- Pyrexia.
- Periventricular bleed.
- Convulsion.
- Sedation e.g. diazepam.
Treatment
- Stimulation may restart breathing, especially if done promptly.
- Gently clearing the airway and mask ventilation if stimulation is unsuccessful.
- Nasal CPAP may prevent further apnoea. Do not give added oxygen unless oxygen
saturation is low. - Intubation and ventilation may be necessary in severe, recurrent apnoae.
- Look for and treat underlying cause.
How is apnea of prematurity defined?
Apnea of prematurity is defined as cessation of breathing for more than 20 seconds or a shorter respiratory pause associated with oxygen desaturation and/or bradycardia in infants younger than 37 weeks gestation.
What is the incidence of apnea in preterm infants?
The incidence of apnea is inversely proportional to gestational age, with almost all extremely low birth weight infants (GA < 28 weeks) being affected. It is usually first noticed after the second day.
How is apnea of prematurity diagnosed?
Apnea of prematurity is diagnosed as a diagnosis of exclusion, meaning that other potential causes of apnea in preterm infants must be ruled out before making this diagnosis
What are some components of management for infants experiencing apnoea?
Minimal handling, close temperature control, monitoring with apnoea alarm or pulse oximeter, and administration of prophylactic oral caffeine or theophylline.
Which drug is preferred for prophylaxis in infants with apnoea?
Caffeine
Why is caffeine preferred over theophylline for prophylaxis in infants with apnoea?
Due to its safety profile.
What is the usual gestational age threshold for infants to be considered mature enough for discontinuation of prophylactic drugs for apnoea?
Usually 33 weeks.
If apnoea persists despite prophylactic drug administration, what is the next recommended step?
Nasal continuous positive airway pressure (CPAP).
In cases where mechanical ventilation is necessary for infants with apnoea, what does it suggest?
It suggests another cause for the apnoea.
