Apnoea of Prematurity

Question 1

What is apnoea of prematurity?

Answer 1

Apnoea are defined as periods where breathing stops spontaneously for more than 20 seconds, or shorter periods with oxygen desaturation or bradycardia. Apnoea can occur in neonates of all gestational ages. They are often accompanied by a period of bradycardia.

Apnoea is very common in premature neonates. They occur in almost all babies less than 28 weeks gestation and the incidence decreases with increased gestational age. In term infants apnoea usually indicate underlying pathology.

Question 2

What causes apnoea of prematurity?

Answer 2

Apnoea occur due to immaturity of the autonomic nervous system that controls respiration and heart rate. This system is more immature in premature neonates.

Apnoea are often a sign of developing illness, such as:

• Infection
• Anaemia
• Airway obstruction (may be positional)
• CNS pathology, such as seizures or haemorrhage
• Gastro-oesophageal reflux
• Neonatal abstinence syndrome

Question 3

Briefly describe the management of apnoea of prematurity

Answer 3

Neonatal units attach apnoea monitors to premature babies. These make a sound when an apnoea is occurring. Tactile stimulation is used to prompt the baby to restart breathing. Intravenous caffeine can be used to prevent apnoea and bradycardia in babies with recurrent episodes.

Episodes will settle as as the baby grows and develops.