After they're born, babies must breathe
continuously to get oxygen. In a
premature 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 is apnea of prematurity, or AOP.
About Apnea of Prematurity
Apnea of prematurity is fairly common in preemies. 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 no doubt about it - it's frightening
while it's happening.
Apnea is a medical term that means a baby has stopped breathing.
Most experts define apnea of prematurity as a condition in which
premature infants 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 the birth. The lower
the infant's weight and level of prematurity at birth, the more
likely he or she will have AOP.
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 should not be confused with periodic breathing, which is
also common in premature newborns. 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.
Treatment
Most of the time, premature infants (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
infants must get help breathing because their lungs are too
immature to allow them to breathe on their own.
The following devices help with breathing:
Ventilator.
During mechanical ventilation, a tube is placed into the baby's
trachea (windpipe) and breaths of air are blown through the tube
into the 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 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.
Continuous positive airway pressure (CPAP).
When infants are disconnected from a mechanical ventilator, they
often 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 baby's nose,
which is hooked to a machine that provides oxygenated air into the
air passages and lungs. The pressure from the CPAP machine helps
keep a preemie'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.
Monitoring Breathing
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 unassisted and 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 lungs. Usually
only a few breaths are needed before the baby begins to breathe
again on his or her own.
AOP can 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. If a baby begins to have
many apnea spells, medication might be 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
preemies go home, a few will continue to have them. In these cases,
if the doctor thinks it's necessary, the baby will be
discharged from the NICU with an apnea monitor.
An apnea monitor has two main parts: a belt with sensory wires
that a baby wears around the chest and a monitoring unit with
an alarm. The sensors measure the baby's chest movement and
breathing rate while the monitor continuously records these
rates.
Before your 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 your baby isn't breathing or his or her 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 can 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 doctor will determine how long your baby wears the monitor,
so be sure to ask if you have any questions or concerns.
Caring for Your Baby
Apnea of prematurity usually resolves on its own with time. For
most preemies, 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. A healthy baby who is
apnea free for a week will probably never have AOP again.
Although
sudden infant death syndrome (SIDS)
does occur more often in premature infants, no relationship between
AOP and SIDS has ever been proved.
Aside from AOP, other complications with your premature baby may
limit the time and interaction that you can have with your child.
Nevertheless, you can bond with your baby in the NICU. 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 their
parents.
Reviewed by:
Michael L. Spear, MD
Date reviewed: June 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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