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Premature Baby
Premature Baby-Apnea
 Once a baby is
born, he or she needs to breathe continuously to get oxygen. In a preemies baby,
the part of the central nervous system (brain and spinal cord) that controls
breathing is not yet mature enough to allow nonstop breathing. This causes large
bursts of breath followed by periods of shallow breathing or stopped breathing.
The medical term for this condition is apnea of prematurity, or AOP.
Apnea of
prematurity is fairly common in a premature baby . Doctors usually diagnose the condition
before the mother and baby are discharged from the hospital, and the apnea
usually goes away on its own as the infant matures. Once apnea of prematurity
goes away, it does not come back. But there's no doubt about it - it's
frightening while it's happening.
What Is Apnea of Prematurity?
Apnea is a
medical term that means a premature baby has stopped breathing. Most experts define apnea
of prematurity as a condition in which premature babies stop breathing for 15
to 20 seconds during sleep.
Generally,
babies who are born at less than 35 weeks' gestation have periods when they stop
breathing or their heart rates drop. (The medical name for a slowed heart rate
is bradycardia). These breathing abnormalities may begin after 2 days of life
and last for up to 2 to 3 months after these premature babiesare born. The
lower the infant's weight and level of prematurity at birth, the more likely it
is that the infant will have AOP spells.
 Although it's
normal for all infants to have pauses in breathing and heart rates, those with
AOP have drops in heart rate below 80 beats per minute, which causes them to
become pale or bluish. They may also appear limp, and their breathing may be
noisy. They then either start breathing again by themselves or require help to
resume breathing.
AOP may happen
once a day or many times a day. Doctors will closely evaluate your infant to
make sure the apnea isn't due to another condition, such as infection or
internal bleeding.
Apnea of
prematurity should not be confused with periodic breathing, which is also common
in premature babies. Periodic breathing is marked by a pause in breathing that
lasts just a few seconds and is followed by several rapid and shallow breaths.
Periodic breathing is not accompanied by a change in facial color (such as
blueness around the mouth) or a drop in heart rate. A baby who has periodic
breathing resumes regular breathing on his or her own.
Although it can
be frightening, periodic breathing typically causes no other problems in
newborns.
How Is Apnea of Prematurity
Treated?
Most of the
time, premature babies(especially those less than 34 weeks' gestation at birth)
will receive medical care for apnea of prematurity in the hospital's neonatal
intensive care unit (NICU). When they are first born, many of these premature
babies must get help breathing from a ventilator because their lungs are too
immature to allow them to breathe on their own.
 During
mechanical ventilation, a tube is placed into the premature baby's trachea (windpipe) and
breaths of air are blown through the tube into the premature baby's lungs. These breaths
are given at a set pressure. The ventilator is also programmed to give a certain
number of breaths per minute, and the premature baby's breathing, heart rate, and oxygen
levels are continuously monitored.
Sometimes
babies with apnea of prematurity are given medications to help mature their
lungs and allow the preemies to come off mechanical ventilation within a few
weeks and breathe on their own.
When infants
are disconnected from a mechanical ventilator, often they require a form of
assisted breathing called nasal continuous positive airway pressure
(CPAP). A nasal CPAP device consists of a large tube with tiny prongs that fit
into the premature baby's nose, which is hooked to a machine that provides oxygenated air
into the baby's air passages and lungs. The pressure from the CPAP machine helps
keep a premature baby's lungs open so he or she can breathe. However, the machine does
not provide breaths for the baby, so the baby breathes on his or her own.
Once preemies
are off a mechanical ventilator and breathing on their own - with or without
nasal CPAP - they are monitored continuously for any evidence of apnea. The
cardiorespiratory monitor (also known as an apnea and bradycardia,
or A/B, monitor) also tracks the infant's heart rate. An alarm on the monitor
sounds if there's no breath for a set number of seconds. When the monitor sounds,
a nurse immediately checks the baby for signs of distress. False alarms are not
uncommon.
If a baby
doesn't begin to breathe again within 15 seconds, a nurse will rub the baby's
back, arms, or legs to stimulate the breathing. Most of the time, babies with
apnea of prematurity spells will begin breathing again on their own with this
kind of stimulation.
 However, if the
nurse handles the baby, and the baby still hasn't begun breathing on his or her
own and the baby becomes pale or bluish in color, oxygen may be administered
with a handheld bag and mask. The nurse or doctor will place the mask over the
infant's face and use the bag to slowly pump a few breaths into the baby's lungs.
Usually only a few breaths are needed before the baby begins to breathe again on
his or her own.
If a baby
begins to have many such apnea spells, medication is sometimes given
intravenously or by mouth to stimulate the part of the brain that controls
breathing. This often reduces the apnea spells.
When Your Baby Is on a Home
Apnea Monitor
Although apnea
spells are usually resolved by the time most premature babies go home, a few will
continue to have apnea spells. In these cases, if the doctor thinks it's
necessary, the premature baby will be discharged from the NICU with an apnea monitor.
An apnea
monitor consists of two main parts: a belt with sensory wires that your child
wears around his or her chest and a monitoring unit with an alarm. The sensors
measure the premature baby's chest movement and breathing rate while the monitor
continuously records these rates. Before the baby leaves the hospital, the NICU
staff will thoroughly review the monitor with you and give you detailed
instructions on how and when to use it, as well as how to respond to an alarm.
Parents and caregivers will also be trained in infant CPR, even though it's
unlikely they'll ever have to use it.
 If the baby
isn't breathing when you check him or her or your baby's face seems pale or
bluish, follow the instructions given to you by the NICU staff. Usually, your
response will involve some gentle stimulation techniques and, if these don't
work, starting CPR and calling 911. Remember, never shake your baby to wake him
or her.
It can be very
stressful to have a baby at home on an apnea monitor. Some parents find
themselves watching the monitor, afraid even to take a shower or run to the
mailbox. This usually becomes easier with time. If you're feeling this way, it
may help to share your feelings with the NICU staff. They may be able to
reassure you and even put you in touch with other parents of preemies who have
gone through the same thing.
Your child's
doctor will determine how long your baby wears the monitor, so be sure to talk
to him or her if you have any questions or concerns.
Caring for Your Child
Apnea of
prematurity usually resolves on its own with time. For most premature babies, this means
AOP stops around 44 weeks of postconceptional age. Postconceptional age is
defined as the gestational age (how many weeks of pregnancy at the time of birth)
plus the postnatal age (weeks of age since birth). In rare cases, AOP continues
for a few weeks longer.
 Healthy infants
who have had AOP usually do not go on to have more health or developmental
problems than other babies. The apnea of prematurity does not cause brain damage.
If a healthy baby is apnea free for a week, he or she will probably never have
apnea again.
Although sudden
infant death syndrome (SIDS) does occur more often in premature infants, no
relationship between AOP and SIDS has ever been proven.
Aside from AOP,
there may be other complications with your premature baby that may limit the
time and interaction that you can have with your child. Nevertheless, you can
bond with your baby in the NICU. It's a good idea to talk to the NICU staff
about what type of interaction would be best for your baby, whether it's
holding, feeding, caressing, or just speaking softly. The NICU staff is not only
trained to care for premature babies, but also to reassure and support the
parents of preemies.
Reviewed by:
Michael L. Spear, MD
Clinical Director, NICU
Medical Director, Infant Apnea Team
Division of Neonatology
Alfred I. duPont Hospital for Children
Wilmington, DE
Clinical Professor of Pediatrics
Jefferson Medical College
Philadelphia, PA
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