Apnea in the newborn

Abstract

Apnea, defined as cessation of breathing resulting in pathological changes in heart rate and oxygen saturation, is a common occurrence especially in preterm neonates. It is due to immaturity of the central nervous system (apnea of prematurity) or secondary to other causes such as metabolic disturbances etc. Secondary causes of apnea should be excluded before a diagnosis of apnea of prematurity is made. Methylxanthines and continuous positive airway pressure form the mainstay of treatment. Mechanical ventilation is reserved for apnea resistant to the above therapy. An approach to the management of apnea in neonates is described.

Apnea in preterm newborns: determinants, pathophysiology, effects on cardiovascular parameters and treatment

“…It is due to a immaturity of their systems, mainly of the central nervous system. Therefore, it is necessary to exclude secondary causes of apnea before a diagnosis apnea of prematurity (AoP) is done (41).…”

Pathogenesis and Management of Apnea of Prematurity: A Brief Overview

“…Although attributed to prematurity in majority of the cases, apnea of prematurity is a diagnosis of exclusion and therefore, a thorough evaluation for secondary causes such as sepsis of the newborn, necrotizing enterocolitis, intraventricular hemorrhage, maternal use of opiate or magnesium sulfate, anemia, hypothermia, hypoglycemia etc, should be performed depending upon the clinical presentation, especially when it occurs for the first time after the 2 nd week of life in a previously well infant, or in an infant who was not having any episodes for more than 5-7 days [16,17].…”

“…The management of apnea of prematurity starts with eliminating the factors that increase the risk of apnea such as maintenance of a stable thermal environment and nasal patency, and avoidance of extreme neck flexion and extension [17,18]. In preterm infants with obstructive or mixed apnea, nasal continuous positive pressure (CPAP) or oxygen/ air flow through a nasal canula may help to decrease the frequency and severity of episodes [16][17][18]. Methylxanthine therapy especially with caffeine has been shown to be effective in the treatment of symptomatic preterm infants with apnea of prematurity, due to its ability to cause central nervous system stimulation by competitive inhibition of adenosine receptors [19].…”

“…Caffeine is preferred over theophylline because of its longer half-life and a lower incidence of adverse effects [20]. It is given as a loading dose of 20 mg/kg of caffeine citrate orally or intravenously over 30 minutes, followed by a daily maintenance dose of 5 to 8 mg/kg per dose either orally or intravenously [16,18]. In infants with persistent apneic episodes, an additional loading dose of caffeine citrate (10 mg/kg) may be given followed by an increase in the daily maintenance dose by 20 percent [16,18].…”

“…It is given as a loading dose of 20 mg/kg of caffeine citrate orally or intravenously over 30 minutes, followed by a daily maintenance dose of 5 to 8 mg/kg per dose either orally or intravenously [16,18]. In infants with persistent apneic episodes, an additional loading dose of caffeine citrate (10 mg/kg) may be given followed by an increase in the daily maintenance dose by 20 percent [16,18]. Caffeine has been shown to have a beneficial effect not only for apnea of prematurity, but for other neonatal morbidities such as bronchopulmonary dysplasia, patent ductus arteriousus, and post-operative apnea as well [19,21].…”