Apnea of Prematurity

Apnea of prematurity refers to what happens when a child doesn’t breathe for more than 20 seconds. It is more common in premature babies than in full-term babies. The more premature the baby, the greater the chances of apnea. About half of all premature babies have apnea of prematurity.

Most babies who develop apnea are premature. It appears to be more common during sleep, especially during active sleep — a period when your baby has rapid eye movement (REM) while sleeping.

Apnea may be followed by bradycardia (decreased heart rate). With bradycardia, when your baby’s breathing slows, the heart rate also slows. A common term for apnea with bradycardia is "As and Bs."

While each baby may experience apnea of prematurity differently, some of the most common symptoms include:

• Periods of absent breathing for 20 seconds or more
• Symptoms begin during in the first week of life or later

Signs of the more serious forms of apnea of prematurity may include:

• Longer periods of absent breathing
• Blue coloring
• Bradycardia

Apnea of prematurity may be confused with another breathing pattern called periodic breathing. Periodic breathing:

• Is a pattern of short pauses followed by a burst of faster breaths
• May affect both premature and full-term babies
• Is a normal type of breathing in babies

Unlike periodic breathing, apnea of prematurity can be a symptom of a more serious condition. The symptoms of apnea of prematurity may resemble other conditions or medical problems.

Apnea of prematurity may have several causes, resulting in two main kinds of apnea:

• Central apnea: This kind of apnea is due to a disturbance in a child’s brain's breathing control center. Problems in her organs might also affect this breathing control center.
• Obstructive apnea: With this kind of apnea, a child’s breathing stops because something is blocking the child’s airway.

Apnea of prematurity may also be caused simply because a child has an immature central nervous system, or conditions including:

• Bleeding or tissue damage in your baby’s brain
• Respiratory disease
• Infections
• Gastrointestinal problems such as reflux (your baby’s stomach contents move back up into the esophagus)
• Your baby’s levels of chemicals such as glucose or calcium are too high or too low
• Heart or blood vessel problems
• The stimulation of reflexes that can trigger apnea such as with feeding tubes or suctioning, or when your baby's neck is very flexed
• Unstable temperature

It is important to find out if your baby’s apnea is due primarily to prematurity or if it is caused by another problem. Your baby's physician will check many of her body systems to find out what might be causing the apnea. Diagnostic procedures may include:

• Physical examination
• Blood tests to check for blood counts, oxygen level, electrolyte levels, and infection
• X-ray to check for problems in the lungs, heart or gastrointestinal system
• Apnea study to monitor breathing effort, heart rate, and oxygenation

When your baby has apnea, stimulating her by patting or rubbing her skin can help her to begin breathing again. Your baby's treatment plan for apnea of prematurity may also include:

• Monitoring of her breathing and heart rates
• Medications
• Caffeine or theophylline to stimulate the central nervous system
• Continuous positive airway pressure (CPAP): a mechanical breathing machine that pushes a continuous flow of air or oxygen to the airways to help keep tiny air passages in your baby's lungs open

Many premature babies will "outgrow" apnea of prematurity by the time they are 36 weeks. If the apnea is not due to prematurity, your baby may require other treatments.

At Boston Children’s Hospital we treat apnea through one of our childhood respiratory programs, such as the Center for Healthy Infant Lung Development (CHILD). At CHILD, we offer a comprehensive, team-based approach to maximize the growth and development of your child’s lungs. Our staff is available 24 hours per day, seven days per week, and we pride ourselves in how available we are to our families.