Introduction
The term ‘apnea’ refers to cessation of breathing for more than 20 seconds. Apnea can occur due to immaturity of the brain and also due to the weakness of the muscles that keep the airway open. Sometimes, added stresses in a premature baby, like low blood count, heart or lung issues, infection, temperature problems, low oxygen levels, overstimulation, and feeding problems, can aggravate apnea. A majority of premature babies suffer from a certain degree of apnea since the area of the brain that controls breathing is still under development.
Why Does Apnea of Prematurity Occur?
Apnea of prematurity can occur due to several reasons, which can result in the following two major kinds of apnea, namely:
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Central Apnea: This type of apnea can occur due to an issue in the breathing control center of the child’s brain. Any problem in the baby’s organs can also influence the breathing control center.
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Obstructive Apnea: In this type of apnea, there is a cessation of the child’s breathing since something obstructs the child’s airway.
Apnea of prematurity can occur either due to an immature central nervous system or due to certain conditions like:
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Tissue damage or bleeding in the baby’s brain.
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Issues in the heart or blood vessels.
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Infections.
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Gastrointestinal issues like reflux.
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The levels of calcium or glucose are either too low or too high.
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Unstable temperature.
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The stimulation of certain reflexes can stimulate apnea, like when the baby’s neck is very flexed or due to the presence of feeding tubes or suctioning.
What Exactly Happens in Apnea of Prematurity?
Apnea of prematurity is a common issue in preterm babies. Healthcare professionals usually diagnose this condition before the baby and the mother are discharged from the hospital. Usually, apnea resolves on its own as the infant matures. In general, babies who are born at less than 35 weeks of gestation usually experience periods when their heart rates drop, or there is a cessation of breathing for short periods. These breathing issues can manifest two days after birth and can last for up to two to three months after birth.
Though it is normal for all babies to experience transient cessations in breathing and heart rates, those with apnea of prematurity have drops in heart rate below 80 beats per minute. This can turn the baby pale or bluish. The baby’s breathing may be noisy, and they may look limp. They might either resume breathing again on their own or might require help to do so.
Apnea of prematurity differs from periodic breathing, which also commonly occurs in premature newborns. A pause in breathing that occurs for just a few seconds, followed by many fast and shallow breaths, is called periodic breathing. Periodic breathing does not alter the facial color or cause a drop in heart rate. Babies who experience periodic breathing usually resume regular breathing on their own. Though this might seem scary, periodic breathing usually does not cause other issues.
What Are the Signs and Symptoms of Apnea of Prematurity?
The signs and symptoms are as follows:
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Cessation of breathing for 20 seconds or more.
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Drop in heart rate (bradycardia).
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Cyanosis (bluish color of the skin).
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Low oxygen levels (desaturation or desat).
How Can Apnea of Prematurity Be Diagnosed?
It is necessary to identify if the infant’s apnea is primarily due to prematurity or if it is due to other issues. The physician will carry out the following diagnostic procedures to identify what might be causing the apnea:
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Physical examination.
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X-ray to check for issues in the heart, lungs, or gastrointestinal system.
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Blood tests to check for oxygen levels, blood counts, infection, and electrolyte levels.
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Apnea study to monitor heart rate, breathing effort, and oxygenation.
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Laboratory tests to check the fluid around the brain and spinal cord, stool, and urine to detect infection and other issues.
How Can Apnea of Prematurity Be Treated?
The treatment of apnea depends on the cause, severity of episodes, and how often it occurs. Infants who experience occasional minor episodes and are otherwise healthy are just observed. In these babies, the episodes resolve when the infants are gently stimulated or touched during periods of breathing cessation. Breathing can be assisted by slower feeding time, proper positioning, oxygen, and the use of a ventilator in extreme cases. Some babies who continue to experience apnea but are otherwise healthy may be discharged from the hospital and may be put on a home apnea monitor (with or without caffeine) until they develop a mature breathing pattern. The following are some of the ways in which apnea of prematurity can be treated:
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Medications.
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Monitoring the baby’s heart and breathing rates.
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Continuous positive airway pressure (CPAP- a mechanical breathing device that pushes a continuous flow of oxygen or air to the airways to assist in keeping the tiny air passages in the infant’s lungs open).
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Theophylline or caffeine stimulates the central nervous system. Caffeine aids in regularizing the breathing pattern.
A majority of premature babies will overcome apnea of prematurity by 36 weeks. However, if the apnea of prematurity is not due to prematurity, then other treatments may be required.
Can Apnea of Prematurity Result in Complications?
Premature babies encounter various problems and usually stay in the hospital for a prolonged period of time. Apnea of prematurity occurs in babies who are born too early. Decreased heart rate and low oxygen levels in the blood can occur with apnea of prematurity. These babies may be at risk of respiratory failure and death. They may also suffer from long-term lung issues.
Mild apnea does not have long-term complications. However, preventing severe or multiple episodes is necessary for the well-being of the baby in the long run. Apnea of prematurity usually resolves as the infant approaches their expected ‘due date’. In a few cases, such as those babies who have severe lung disease or are born very prematurely, apnea may persist a few weeks longer.
Conclusion:
Apnea of prematurity occurs when an infant does not breathe for more than 20 seconds. Premature babies are more susceptible when compared to full-term babies. The more premature the baby, the higher the chances of experiencing apnea. About half of all premature infants suffer from apnea of prematurity. This condition tends to occur more often during sleep, particularly during active sleep (a period when the baby has rapid eye movement while sleeping). Apnea may be followed by decreased heart rate (bradycardia). With decreased heart rate, the baby’s breathing can also retard, which can slow down the heart rate. In a majority of cases, the condition resolves when the baby approaches their expected ‘due date’. Medical intervention can also help manage the condition.
