Apnea (newborn)

Apnea, or apneic pause, is the absence of breath lasting longer than 20 seconds with a decreased in O2 saturation (cyanosis) or even bradycardia (heart rate < 100/min.).hey often appear in premature babies as so-called idiopathic apnea caused by the immaturity respiratory center.

Types of apnea according to etiopathogenesis
Airflow is absent, but respiratory movements are preserved. They are most often of pharyngeal origin, the provoking factors include, among others. pronation position = prone position and head flexion. Other causes: obstruction of airways stenosis, atresia compression of airways.
 * Obstructive

There is a lack of air flow and breathing movements. Causes: immaturity, maternal or child medication, sepsis, congenital heart defects, CNS insults– congenital developmental defects, trauma, bleeding, inflammation, convulsions, hypothermia/hyperthermia, shock, asphyxia, anemia. Metabolic causes- acidosis, hypoglycemia, hypocalcemia, hyponatremia, DPM.
 * Central (most common)

They usually start as peripheral with a subsequent central respiratory disorder. They are most often associated with accompanying bradycardia.
 * Mixed

Cause: GER – the intermediary here is the vagus nerve.
 * Reflective

nterruption of breathing for more than 15-20 s without a clear pathological cause. In premature infants who do not have fully developed axodendritic connections of respiratory neurons in the brainstem – they respond to hypoxia with an apneic pause instead of hyperventilation. Common in children with a birth weight of less than 1000 g, the incidence subsides after 36 weeks of postconceptional age.
 * Idiopathic

Note: any apnea in a term newborn should be considered pathological.

Caused by intracranial hemorrhage, Respiratory distress syndrome (pediatrics), sepsis, aspiration, maternal drug abuse, airway obstruction, pneumonia, meningitis…
 * Symptomatic

Clinical picture
Apnoeic pause, cyanosis, hypotonia, bradycardia.

Diagnosis
„Baby sense monitor“, monitoring of vital functions, pulse oximetry, (pauses lasting < 10 seconds, which often accompany feeding, defecation or movements of the newborn, should be excluded ).

Therapy

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

Related Articles

 * Dyspnea