Apnoeas of prematurity

Question 1

What are apnoeas?

Answer 1

• periods when breathing stops spontaneously for >20 seconds, or shorter periods with oxygen desaturations or bradycardia
• they’re often accompanied by a period of bradycardia

Question 2

Who are apnoeas common in?

Answer 2

1. premature neonates
2. occur in almost all babies <28 weeks gestation and the incidence decreases with increased gestational age
3. in term infants apnoea usually indicated underlying pathology

Question 3

What causes apnoeas?

Answer 3

Due to immaturity of the ANS that controls respiration and heart rate, which is more immature in premature neonates.

Question 4

What are apnoeas a sign of?

Answer 4

Apnoea are often a sign of developing illness eg:

1. infection
2. anaemia
3. airway obstruction
4. CNS pathology eg. seizures or haemorrhage
5. gastro-oesophageal reflux
6. neonatal abstinence syndrome (withdrawal from drugs like opioids that the baby was exposed to in the womb)

Question 5

management?

Answer 5

• NNU attach apnoea monitors to premature babies to make a sound when an apnoea is occurring
• tactile stimulation is used to prompt the baby to restart breathing
• IV caffeine can be used to prevent apnoea and bradycardia in babies with recurrent episodes
• episodes will settle as the baby grows and develops