Apnea of Prematurity

Picture of a newborn in the neonatal intensive care unit

What is apnea of prematurity?

Apnea is a term for the absence of breathing for more than 20 seconds. It can occur in full-term babies, but is more common in premature babies. The more premature the baby, the greater the chances that apnea will occur.

Apnea may be followed by bradycardia, which is a decreased heart rate. When breathing slows, the heart rate also slows. A common term for apnea with bradycardia is "As and Bs."

What causes apnea of prematurity?

Apnea of prematurity may be due to a disturbance in the brain's breathing control center called central apnea. With obstructive apnea, breathing stops because something is blocking the airway. Problems in other organs can also affect the breathing control center. Apnea of prematurity may not have an identifiable cause other than immaturity of the central nervous system. However, apnea of prematurity may have other causes. Some of these include:

  • Bleeding or tissue damage in the brain

  • Respiratory disease

  • Infections

  • Gastrointestinal problems, such as reflux (when the stomach contents move back up into the esophagus)

  • Too low or too high levels of chemicals in the body, such as glucose or calcium

  • Heart or blood vessel problems

  • Immature neurologic system

  • Stimulation of reflexes that can trigger apnea, such as with feeding tubes or suctioning, or when a baby's neck is very flexed

  • Unstable temperature

  • Unknown

Who is affected by apnea of prematurity?

Most babies who develop apnea are premature. It appears to be more common during sleep, especially during active sleep. This is a period when the baby has rapid eye movement (REM) while sleeping. About half of all premature babies have apnea of prematurity.

What are the symptoms of apnea of prematurity?

Apnea of prematurity may be different from another breathing pattern that can occur in both premature and full term newborns, called periodic breathing, a pattern of short pauses followed by a burst of faster breaths. While periodic breathing is a normal type of breathing in babies, apnea of prematurity can be a symptom of a more serious condition.

The following are the most common symptoms of apnea of prematurity. However, each baby may experience symptoms differently. Symptoms may include:

  • Periods of absent breathing for 20 seconds or more

  • Apnea of prematurity beginning in the first week of life or later

Symptoms of the more serious forms of apnea of prematurity may include:

  • Longer periods of absent breathing

  • Apnea beginning right after birth or after the second week

  • Blue coloring

  • Severe decrease in heart rate (bradycardia)

The symptoms of apnea of prematurity may resemble other conditions or medical problems. Always consult your baby's doctor for a diagnosis.

How is apnea of prematurity diagnosed?

It is important to find out if the apnea is due primarily to prematurity or if it is caused by another problem. Your baby's doctor will check many of your baby's body systems to find out what might be causing the apnea. Diagnostic procedures may include:

  • Physical examination

  • Blood tests. These are done to check for blood counts, electrolyte levels, and infection.

  • Other laboratory tests, such as nasal swabs to check for certain viral infections 

  • Measurement of the levels of oxygen in the baby's blood

  • X-ray. An X-ray is a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film to check for problems in the lungs, heart, or gastrointestinal system.

  • Apnea study. This is done to monitor breathing effort, heart rate, and oxygenation.

Treatment for apnea of prematurity

When apnea occurs, stimulation of the baby by rubbing the skin or patting can help the baby begin breathing again. However, any problems that might be causing the apnea need to be identified and treated. Many premature babies will "outgrow" apnea of prematurity by the time they reach the date that would be the same as 36 weeks gestation.

Specific treatment for apnea of prematurity will be determined by your baby's doctor based on:

  • Your baby's gestational age, overall health, and medical history

  • Extent of the condition

  • Your baby's tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

Treatment for apnea of prematurity may include:

  • Monitoring of breathing and heart rates

  • Medications:

    • Caffeine or theophylline to stimulate the central nervous system

  • Continuous positive airway pressure. A mechanical breathing machine that pushes a continuous flow of air or oxygen to the airways to help keep tiny air passages in the lungs open.

Apnea not due to prematurity may require other treatments.