What is Apnoea?   

Before birth the foetus has an irregular breathing rhythm with frequent pauses, called periodic breathing. After birth this has to become regular. The breathing control systems need some time to adapt and periodic breathing is frequently seen in the more immature babies.

If the pause in breathing lasts for longer than 20 seconds, or if this period is accompanied by a slowing of the heart rate (the medical word for this is bradycardia) or by decreasing oxygen levels (measured as oxygen saturation), professionals call it apnoea.

Breathing control becomes regular over the preterm period and most babies grow out of apnoea in the preterm period.

Who is affected and what are the risk factors?

Apnoea is fairly common health problem in preterm babies, as the central nervous system that controls breathing is not yet mature enough to allow regular breathing: Approximately 70% of preterm babies born before 34 weeks of gestation have apnoeas to some degree. The earlier a baby is born, the higher is the risk of developing apnoea.

What is the cause?

Although most apnoea result from periodic breathing, this may be made worse in the presence of lung disease or infection.  Also in situations where adults breath faster (for example during illness or painful procedures) the baby responds with periodic breathing.  Therefore, the doctor may want to perform some tests and offer treatment if apnoea increases in frequency or is troublesome.

How is it diagnosed?

By monitoring breathing, heart rate and oxygen saturation the healthcare team in the neonatal intensive care unit (NICU) can easily detect apnoea. If apnoea shows an unexpected course or if it lasts for a long time, the medical team may arrange different diagnostic tests, e.g. blood or urine tests or ultrasound, to find out if apnoea appears to be a symptom of some other condition.

How is it managed?

Babies in the NICU are constantly monitored. If an apnoea occurs, the healthcare team can immediately react to it. A small amount of physical stimulation (for example by gently touching the baby’s back or feet) can help the baby to begin regular breathing again. Sometimes, preterm babies may receive medication (usually caffeine medicine) to reduce apnoeic episodes. In some cases oxygen or respiratory support may be required.

 
© 2017 EFCNI - European Foundation for the Care of Newborn Infants
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