[12] Apnoea Flashcards
Define apnoea
Cessation of respiratory airflow for 20 seconds or longer
What are the 3 main categories of apnoea?
- Central
- Obstructive
- Mixed
What happens in central apnoea?
Inadequate medullary response leading to no or poor muscle co-ordination for breathing
What can cause central apnoea?
- Cessation of output from the central respiratory centres
- Inability of efferent peripheral nerves or respiratory muscles to process or receive signals from the brain
What is obstructive apnoea?
When there is an obstruction of the airways and therefore poor to no air exchange
How is the inspiratory effort affected in obstructive apnoea?
It is usually vigorous but has no effect against the obstruction
Which type of apnoea is most common in children?
Obstructive
What is mixed apnoea?
Where there is an episode with combinations of central and obstructive apnoea
What are the common causes of apnoea?
- Apnoea of prematurity
- Infections
- Cardiovascular
- Pain
- CNS
- Respiratory
- GI
- Metabolic
- Drugs
- Head and neck positioning
When does apnoea of prematurity occur?
2-7 days of life
What are the infective causes of apnoea?
- Sepsis
- Necrotising enterocolitis
- Meningitis
What are the cardiovascular causes of apnoea?
- Anaemia
- Hypo/hypertension
- PDA
- Cardiac failure
- Hypovolaemia
What are the pain causes of apnoea?
- Acute
- Chronic
What are the CNS causes of apnoea?
- Intraventricular haemorrhage
- Seizures
- Hypoxic injury
- Neuromuscular disorders
- BRainstem infarction or anomalies
- Congenital malformations
What are the respiratory causes of apnoea?
- Pneumonia
- Intrinsic or extrinsic mass or lesions causing airway obstruction
- Upper airway collapse
- Atelectasis
- Phrenic nerve palsy
- RDS
- Pneumothorax
- Hypoxia
- Malformations of chest
- Pulmonary haemorrhage
- Aspiration
What are the GI causes of apnoea?
- Oral feeding
- Bowel movement
- Oesophagitis
- Intestinal perforation
- GORD
- Abdominal distension
What are the metabolic causes of apnoea?
- Hypoglycaemia
- Hypocalcaemia
- Hyperammonaemia
What drugs can cause apnoea?
- Maternal drugs e.g. narcotics
- Opiates
- Sedatives or GA
What is the main risk factor for central apnoea in children?
Prematurity
What are the risk factors for obstructive apnoea?
- Overweight
- Boys
- Other conditions
What other conditions can increase risk of obstructive apnoea?
- Mucopolysaccharoidosis
- Trisomy 21
- Craniofacial abnormalities
How do patients with central apnoea present?
No respiratory effort
What investigations can be undertaken in apnoea?
- Pulse oximetry
- Cardiorespiratory monitoring
- Apnoea monitor for chest wall movement
What must be done if the apnoea is not phyisiological?
Must investigate to identify underlying cause
What are the differentials for apnoea?
- Periodic breathing
- Subtle seizures
What is periodic breathing?
Three or more periods with no respiratory effort lasting 3 seconds or more in a 20 second period
Is periodic breathing a problem?
No, it is a normal neonatal breathing pattern
What does periodic breathing not involve?
Change to colour or heart rate
How is acute apnoea managed?
- Ensure head and neck in the right position
- Tactile stimulation
- Clear the airway
- CPAP or mechanical ventilation
What is tactile stimulation?
Gentle rubbing of the soles of the feet or the chest wall
How may the airway be cleared?
Suction of the mouth and nostrils
What are the potential complications of apnoea?
Permanent brain damage and death
