Apnea of prematurity: from cause to treatment

Abstract

Apnea of prematurity (AOP) is a common problem affecting premature infants, likely secondary to a “physiologic” immaturity of respiratory control that may be exacerbated by neonatal disease. These include altered ventilatory responses to hypoxia, hypercapnia, and altered sleep states, while the roles of gastroesophageal reflux and anemia remain controversial. Standard clinical management of the obstructive subtype of AOP includes prone positioning and continuous positive or nasal intermittent positive pressure ventilation to prevent pharyngeal collapse and alveolar atelectasis, while methylxanthine therapy is a mainstay of treatment of central apnea by stimulating the central nervous system and respiratory muscle function. Other therapies, including kangaroo care, red blood cell transfusions, and CO2 inhalation, require further study. The physiology and pathophysiology behind AOP are discussed, including the laryngeal chemoreflex and sensitivity to inhibitory neurotransmitters, as are the mechanisms by which different therapies may work and the potential long-term neurodevelopmental consequences of AOP and its treatment.

The Use of Caudal/Epidural Catheter as the Primary Anesthetic with Dexmedetomidine Secondary to High Risk of Post-Operative Apnea in Premature Infants

“…Apnea of prematurity is a developmental disorder caused by a lack of respiratory control. Infants with apnea of prematurity have pauses in breathing for over 15 -20 s that may cause oxygen desaturation and bradycardia [9]. Apnea in infants can lead to deleterious effects on neurological development due to anoxia of the CNS [10].…”

Real-time detection, classification, and quantification of apneic episodes using miniature surface motion sensors in rats

“…However, hypopneic and obstructive apneic episodes are usually suspected only when bradycardia and hypoxemia are present, and the infants are already in severe distress or faint (7,(12)(13)(14)17,29). Repeated occurrences of hypoxemic episodes have been associated with impaired neurodevelopment, including mental retardation, cerebral palsy, blindness, growth retardation, and severe learning difficulties (4,15,17,30,31).…”

“…Thus, timely detection and characterization of hypopneic and apneic episodes is of utmost importance. Various modes of interventions have been explored in order to reduce hypoxemic episodes, including physical or sensory-neural stimulation (32), feeding practices (33), positioning (15,17), appropriate pharmacological treatment (5), or respiratory support. However, one of the main obstacles lies in correct identification and quantification of the severity of the apneic episodes, in a simple and practical manner.…”

“…To date, there is no simple and precise modality for early detection of OA (15)(16)(17). While measurement of the esophageal pressure (EP) is the gold standard for quantification of the respiratory effort and for classification of apneic episodes (18,19), it is invasive and causes discomfort.…”

Individualized Developmental Care in Neonatal Intensive Care Unit: Current Approaches: Review

“…olumlu etkiye sahip olduğu belirlenmiştir. [63][64][65][66][67][68] Prematüre bebekler termlere göre hipotonik oldukları için intrauterin pozisyonu sürdürmekte güçlük çekmektedir. Preterm bebekler için "orta hatta el-ağız manevrasını yapabilme ve kendi kendini sakinleştirme gibi öz-düzenleme davranışla-rını kolaylaştıran fetal fleksör pozisyon" en uygun pozisyon olarak tanımlanmaktadır.…”