Apnea of prematurity is a common respiratory challenge in premature infants, characterized by breathing pauses. These episodes occur because the baby’s developing body systems, particularly those regulating breathing, have not yet fully matured.
Understanding Apnea of Prematurity
Apnea in premature infants stems from underdeveloped brain respiratory control centers in the medulla. These centers send signals to the lungs to breathe. When immature, they may not function properly, leading to breathing pauses.
Apnea of prematurity has three main types. Central apnea, the most common, occurs when the brain’s respiratory center fails to send signals to initiate a breath. Obstructive apnea happens with a temporary airway blockage, such as from low muscle tone in the throat or a flexed neck. Mixed apnea combines both central and obstructive types.
Recognizing and Diagnosing Apnea
Healthcare providers monitor premature infants for apnea signs: breathing pauses lasting 20 seconds or more, or shorter pauses with a slow heart rate (bradycardia) or decreased blood oxygen (desaturation). During desaturation, the baby’s skin or lips may appear bluish, pale, or, in newborns of color, yellow-gray, gray, or white. These color changes are often more noticeable in the mucous membranes of the mouth, nose, and eyelids.
In the Neonatal Intensive Care Unit (NICU), medical professionals use equipment to diagnose apnea. Cardio-respiratory monitors continuously track breathing and heart rate, alarming if breathing stops or heart rate drops. Pulse oximetry measures blood oxygen, alerting staff to low levels. Monitor data, combined with nurse observation, confirms the diagnosis and rules out other causes like infection or metabolic disorders.
Treatment and Management Strategies
Management of apnea of prematurity aims to support infant breathing until their respiratory system matures. Caffeine citrate, a common medical intervention, stimulates the central nervous system to increase respiratory drive. It is administered in specific doses.
Respiratory support methods are also used. Continuous Positive Airway Pressure (CPAP) delivers gentle air pressure to keep airways open, while nasal cannula oxygen provides supplemental oxygen. For severe, persistent apnea, mechanical ventilation may be necessary.
Nursing interventions complement medical treatments. Gentle stimulation, such as rubbing the baby’s back or limbs, can prompt breathing during an apneic episode. Proper infant positioning and adjusted feeding techniques also help manage episodes. These strategies reduce apneic event frequency and severity, ensuring adequate oxygenation.
Outlook and Transition Home
Most premature infants outgrow apnea of prematurity as their respiratory systems mature. This typically occurs as the infant approaches full-term gestational age, often by 34 to 36 weeks postmenstrual age. For very premature infants, apnea may persist longer, possibly up to 44 weeks postmenstrual age.
Before discharge, healthcare providers ensure the infant has been free of significant apneic events for 5 to 8 days without intervention. This observation period typically begins after the last caffeine dose and when the infant is no longer on positive pressure respiratory support. Home apnea monitors are not routinely recommended for all infants but may be considered for high risk of recurrent, severe events after discharge. The decision to send an infant home with a monitor is based on individual medical needs and physician preference.