[12] Apnoea Flashcards

1
Q

Define apnoea

A

Cessation of respiratory airflow for 20 seconds or longer

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2
Q

What are the 3 main categories of apnoea?

A
  • Central
  • Obstructive
  • Mixed
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3
Q

What happens in central apnoea?

A

Inadequate medullary response leading to no or poor muscle co-ordination for breathing

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4
Q

What can cause central apnoea?

A
  • Cessation of output from the central respiratory centres

- Inability of efferent peripheral nerves or respiratory muscles to process or receive signals from the brain

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5
Q

What is obstructive apnoea?

A

When there is an obstruction of the airways and therefore poor to no air exchange

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6
Q

How is the inspiratory effort affected in obstructive apnoea?

A

It is usually vigorous but has no effect against the obstruction

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7
Q

Which type of apnoea is most common in children?

A

Obstructive

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8
Q

What is mixed apnoea?

A

Where there is an episode with combinations of central and obstructive apnoea

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9
Q

What are the common causes of apnoea?

A
  • Apnoea of prematurity
  • Infections
  • Cardiovascular
  • Pain
  • CNS
  • Respiratory
  • GI
  • Metabolic
  • Drugs
  • Head and neck positioning
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10
Q

When does apnoea of prematurity occur?

A

2-7 days of life

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11
Q

What are the infective causes of apnoea?

A
  • Sepsis
  • Necrotising enterocolitis
  • Meningitis
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12
Q

What are the cardiovascular causes of apnoea?

A
  • Anaemia
  • Hypo/hypertension
  • PDA
  • Cardiac failure
  • Hypovolaemia
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13
Q

What are the pain causes of apnoea?

A
  • Acute

- Chronic

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14
Q

What are the CNS causes of apnoea?

A
  • Intraventricular haemorrhage
  • Seizures
  • Hypoxic injury
  • Neuromuscular disorders
  • BRainstem infarction or anomalies
  • Congenital malformations
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15
Q

What are the respiratory causes of apnoea?

A
  • 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
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16
Q

What are the GI causes of apnoea?

A
  • Oral feeding
  • Bowel movement
  • Oesophagitis
  • Intestinal perforation
  • GORD
  • Abdominal distension
17
Q

What are the metabolic causes of apnoea?

A
  • Hypoglycaemia
  • Hypocalcaemia
  • Hyperammonaemia
18
Q

What drugs can cause apnoea?

A
  • Maternal drugs e.g. narcotics
  • Opiates
  • Sedatives or GA
19
Q

What is the main risk factor for central apnoea in children?

A

Prematurity

20
Q

What are the risk factors for obstructive apnoea?

A
  • Overweight
  • Boys
  • Other conditions
21
Q

What other conditions can increase risk of obstructive apnoea?

A
  • Mucopolysaccharoidosis
  • Trisomy 21
  • Craniofacial abnormalities
22
Q

How do patients with central apnoea present?

A

No respiratory effort

23
Q

What investigations can be undertaken in apnoea?

A
  • Pulse oximetry
  • Cardiorespiratory monitoring
  • Apnoea monitor for chest wall movement
24
Q

What must be done if the apnoea is not phyisiological?

A

Must investigate to identify underlying cause

25
What are the differentials for apnoea?
- Periodic breathing | - Subtle seizures
26
What is periodic breathing?
Three or more periods with no respiratory effort lasting 3 seconds or more in a 20 second period
27
Is periodic breathing a problem?
No, it is a normal neonatal breathing pattern
28
What does periodic breathing not involve?
Change to colour or heart rate
29
How is acute apnoea managed?
- Ensure head and neck in the right position - Tactile stimulation - Clear the airway - CPAP or mechanical ventilation
30
What is tactile stimulation?
Gentle rubbing of the soles of the feet or the chest wall
31
How may the airway be cleared?
Suction of the mouth and nostrils
32
What are the potential complications of apnoea?
Permanent brain damage and death