Contents Chapter Topic Page Neonatology Respiratory Cardiology

APNOEA IN THE NEWBORN
Definition : Pause in breathing lasting > 15 sec (term) or >20sec (preterm) during
which the infant may develop cyanosis (SpO2 < 80%) and bradycardia (heart rate <
100 per min). In very immature infants, shorter duration of apnoea may produce
bradycardia and cyanosis.
Types: Central – absence of respiratory effort with no gas flow
Obstructive – continued ineffective respiratory effort with no gas flow
Mixed central and obstructive
Periodic breathing – Regular sequence of respiratory pauses of 10-20 sec
interspersed with periods of hyperventilation (4-15 sec) and occurring at least 3x/
minute, not associated with cyanosis or bradycardia.
Aetiology
Symptomatic of underlying problems commoner ones of which are:
1. Respiratory conditions – RDS, pulmonary haemorrhage, pneumothorax,
Upper airway obstruction, respiratory depression 2 drugs
2. Sepsis
3. Hypoxaemia
4. Hypothermia
5. CNS abnormality e.g. IVH, asphyxia, increased ICP, seizures
6. Metabolic disturbances – hypoglycaemia, hyponatraemia, hypocalcaemia
7. Cardiac failure, congenital heart disease, anaemia
8. Aspiration/ Gastro-oesophageal reflux
9. NEC/ Abdomen distension
10. Vagal reflex: Nasogastric tube insertion, suctioning, feeding
Recurrent apnoea of prematurity
- usually occur after 3 days of life with no other pathological conditions. Most
disappear by 34- 36 weeks, but some may persist even after 40 weeks ‘corrected’
gestation.
Management
1. Immediate resuscitation.
Surface stimulation
(Flick soles, touch baby)
Gentle nasopharyngeal suction
(Be careful: may prolong apnoea)
Ventilate with bag and mask on previous FiO2.
Be careful not to use supplementary oxygen if the infant has been in air as the child's
lungs are usually normal and a high PaO2 may result in ROP.
Intubate and IPPV if child cyanosed or apnoea recurrent/persistent