Apnea Of Prematurity

Overview

Apnea of prematurity is a condition in which a baby born too early has pauses in breathing. These pauses can last 15 to 20 seconds or longer, and they may cause the baby's heart rate to slow down or the oxygen level in the blood to drop. It happens because the baby's brain and lungs are not fully mature.

Yes, it is very common. It affects about half of babies born before 34 weeks of pregnancy. The earlier a baby is born, the more likely they are to have apnea.

It affects premature infants, especially those born before 34 weeks of pregnancy. It is more common in babies with lower birth weight and younger gestational age.

Symptoms

Common symptoms

• Pausing in breathing for more than 15 to 20 seconds
• Turning blue or pale around the lips
• Slow heart rate (bradycardia)
• A drop in oxygen levels, often shown by a monitor
• The baby may look limp or floppy during a pause

Symptoms in children

• Apnea of prematurity only affects premature infants. Older children do not have this condition.
• If an older child has pauses in breathing, it may be a sign of a different problem and should be checked by a doctor.

Symptoms in older adults

• Apnea of prematurity does not affect older adults.
• Pauses in breathing in older adults may be due to other conditions, such as sleep apnea, and need separate medical evaluation.

Causes

Main causes

• Immature brain center that controls breathing
• Weak airway muscles that can collapse during sleep
• Lack of fully developed lungs that produce a substance called surfactant, which helps keep air sacs open

Risk factors

• Being born before 34 weeks of pregnancy
• Lower birth weight, especially under 2.5 kg (about 5.5 pounds)
• Having other health conditions common in premature babies, such as infection or anemia
• Being on certain medicines or having surgery

When to see a doctor

See a doctor urgently if:

• If your baby stops breathing and doesn't start again after gentle stimulation
• If your baby turns blue or grey and doesn't improve
• If your baby is limp, unresponsive, or has a seizure

Book a routine appointment if:

• For regular check-ups with your baby's healthcare provider
• If you notice your baby has frequent short pauses in breathing or changes in color during feeding or sleep

Diagnosis

Doctors diagnose apnea of prematurity by observing the baby in the hospital. They use monitoring devices that track breathing, heart rate, and oxygen levels. They also do a physical exam and ask about the baby's medical history.

Tests that may be done

• Continuous monitoring of breathing, heart rate, and oxygen level
• Blood tests to check for infection, low blood sugar, or other issues
• A check for anemia (low red blood cells)
• Imaging tests, such as X-rays, if needed to look at the lungs or brain
• A sleep study, in some cases, to see how the baby breathes during sleep

What to expect at your appointment

The healthcare team will explain the results and what they mean. They may keep your baby in the hospital for monitoring and treatment. If apnea is mild, the team may just watch and give brief stimulation until the baby grows and matures.

Treatment

Treatment for apnea of prematurity depends on how often and how severe the pauses are. The goal is to keep the baby's oxygen levels stable and prevent prolonged breathing pauses. Some babies only need gentle stimulation, while others need medicines or breathing support.

Self-care at home

• Always place your baby on their back to sleep, unless a doctor advises otherwise
• Keep the baby warm, but not overheated
• Gently rub the baby's back or feet to remind them to breathe, if you are instructed by your care team
• Follow your healthcare provider's advice on feeding and monitoring
• Do not smoke around the baby or allow others to smoke nearby

Medical treatments

Doctors may use medicines that help stimulate and regulate breathing. These are given under medical supervision and are not used at home. Some babies may need extra oxygen through tubes or a breathing device, such as continuous positive airway pressure (CPAP). In severe cases, a brief period of mechanical ventilation may be needed. The type of treatment is chosen based on the baby's needs and is always managed by the healthcare team.

Living with this condition

While your baby is in the hospital, you will learn how to care for them and how to use any home monitors if needed. Most babies go home when they can breathe steadily on their own. You will need to follow your care plan and attend regular check-ups.

Lifestyle tips

• Learn infant CPR and how to respond if your baby has a pause
• Keep your baby's sleeping environment safe: firm mattress, no loose bedding or soft toys
• Follow a consistent feeding schedule and watch for signs of feeding problems
• Avoid exposing your baby to sick people or secondhand smoke
• Take care of yourself – ask for help when you need it

Diet and exercise

For a premature baby, nutrition is very important. Your baby may need breast milk or a special formula to help gain weight. Your healthcare team will guide you on feedings. As your baby grows, they will catch up on development. Remember that rest and gentle handling are key – there is no special exercise routine for this condition.

Mental health and emotional wellbeing

Having a baby with apnea of prematurity can be stressful and emotional. It is common to feel anxious, exhausted, or overwhelmed. Talk to your baby's care team about your concerns and ask for support. It is okay to ask for help from family and friends.

Prevention

Apnea of prematurity cannot be prevented in most cases. It is a natural result of premature birth. However, you can help reduce the risk of prematurity by ensuring you have good prenatal care, a healthy lifestyle, and by treating any pregnancy conditions early. After birth, the best way to prevent complications is to follow the care plan and monitor your baby as directed.

Vaccines

Premature babies often need the same vaccines as full-term babies, but the schedule may be adjusted. Talk to your healthcare provider about which vaccines your baby should receive and when.

Screening programmes

In the hospital, babies are screened with breathing and oxygen monitors. After discharge, some babies may need to use a home apnea monitor. Your healthcare provider will let you know if this is needed. There is no routine screening test for all premature babies after discharge.

Complications

If left untreated

• Long pauses in breathing can lead to low oxygen levels, which may harm the brain or other organs
• Slow heart rate can cause decreased blood flow and may lead to serious health issues
• Feeding difficulties and poor weight gain
• Increased risk of infections if the baby is in hospital for long periods

Long-term outlook

The outlook for apnea of prematurity is very good. Most babies stop having pauses by the time they are 36 to 40 weeks old (based on their corrected age). With proper monitoring and treatment, the vast majority of premature infants go on to live healthy lives. Some babies with other complications of prematurity may have longer-lasting issues, but your healthcare team will support you every step of the way.

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