Apnea (neonate)

Apnea is a pause in breathing that lasts 20 seconds or longer with a decrease of oxygen saturation (cyanosis) and also bradycardia (heart rate <&thinsp;100/min.). They often occurs in preterm neonates as a idiopatic apnea caused by the immaturity of the breathing center.

The types of apnea according to the etiopathogenesis
The air flow s missing but the respiratory movements are preserved In most cases, the cause is pharyngeal, the provoking factors include, besides other things a prone position, i.e. laying down on abdomen with head flexion. Other causes are: a mucous congestion of the airways, stenosis, atresia and compression of the airways.
 * Obstructive

There is no air flow and respiratory movement. Causes: immaturity, mother´s of child´s medication, sepsis, congenital heart defects, CNS insults – birth defects and congenital anomalies, trauma, haemorrhage, inflammation, spasms, hypothermia/hyperthermia, shock, asphyxia, anemia. Metabolic causes are: acidosis, hypoglycemia, hypocalcemia, hyponatremia, inborn errors of metabolism.
 * Central (most common)

They often begins as peripheral with subsequent central respiratory failure. They are frequently accompanied by bradycardia.
 * Mixed

The cause is: Gastroesophageal reflux disease (GERD) mediated by the vagus nerve.
 * Reflexive

The cessation of breathing longer than 15–20&thinsp;without any apparent pathology. Frequently seen in preterm neonates who does not have completely matured axodendritic connection of respiratory neurons in the brainstem - they react to hypoxia by the respiratory pause instead of hyperventilation. Neonates under the 1000 g of birth weight are at higher risk. The incidence gets lower after 36. week of conception.
 * Idiopathic

Note: every apnea in full-term neonate should be considered pathological.

Sympthomatic

Caused by intracranial haemorrhage, respiratory distress syndrome, sepsis, aspiration, drug abuse in mother, airway obstruction, pneumonia, meningitis.

Clinical presentation obraz
Respiratory pauses, cyanosis, hypotonia, bradycardia.

Diagnosis
„Baby sense monitor“, monitoring of vital parameters, pulse oximetry, (we should exclude pauses lasting more than 10 seconds, which accompanies feeding or movements of the newborn).

Therapy

 * General precautions:
 * thermoneutral environment (cave! hypothermia),
 * the right head position (cave! anteflexion),
 * orogastric tube preferred over the nasogastric,
 * tactile stimulation,
 * treatment of primary cause,.

Related articles

 * Dyspnoe