Alternative Names

Apnea - newborns; AOP; As and Bs; Blue spell - newborns; Dusky spell - newborns; Spell - newborns

Definition

Apnea is breathing that slows down or stops from any cause. Apnea of prematurity refers to short episodes of stopped breathing in babies who were born before they were due.

Causes, incidence, and risk factors

There are several reasons why newborns, especially premature babies, may have apnea, including:

Their brain is not fully developed
The muscles that keep the airway open are weak

Other stresses in a sick or premature baby may worsen apnea, including:

Anemia
Feeding problems
Heart or lung problems
Infection
Low oxygen levels
Overstimulation
Temperature problems

Symptoms

Newborns, especially preemies, often have an irregular breathing pattern.

These babies will have short episodes (5 - 10 seconds) of either shallow breathing or stopped breathing (apnea). These episodes are followed by periods of normal breathing.

When there is very shallow or no breathing (apnea), the baby may also have a drop in heart rate. This heart rate drop is called bradycardia.

Some babies may also have poor color and an ill-looking appearance. Apnea episodes that last longer than 20 seconds are considered serious.

Signs and tests

Because most preterm and some sick full-term babies have some degree of apnea, these babies are hooked up to monitors in the hospital to watch their breathing, heart rate, and oxygen levels. Apnea or a drop in heart rate can set off the alarms on these monitors.

Treatment

How apnea is treated depends on the cause, how often the breathing stops, and the severity of spells. Babies who appear to be otherwise healthy and have few spells per day are simply watched. They can be gently stimulated during their occasional episodes.

Babies who are well, but who have many episodes in which they stop breathing may be given a caffeine preparation to help stimulate their breathing. Sometimes the nurse will suction children with apnea, change their position, or use a bag and mask to help them breathe.

Proper positioning, slower feeding time, oxygen, and (in extreme cases) a breathing machine may be needed to assist in breathing.

Studies have not been able to show a benefit to putting babies on home monitors, so these monitors are no longer commonly used.

Expectations (prognosis)

Apnea is common in premature babies. Most babies have normal outcomes. Although mild apnea is not thought to have long-term effects, most doctors feel that preventing multiple or severe episodes is better for the baby over the long-term.

Apnea episodes that began after the second week of life or that last longer than 20 seconds are considered more serious.

Apnea of prematurity usually goes away by the baby's 36th week.

References

Owens JA. Sleep medicine. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 18.

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