Apnoea is the cessation of breathing in a premature infant usually within first 2 days of life. It lasts more than 20 seconds, with or without decrease in heart rate or the child turning blue. It can also present once a premature baby comes off breathing support administered by a ventilator in the first few weeks of life.
Such periods of cessation of breathing in a premature infant can be noted with decrease in oxygen saturation levels, lack of chest wall respiratory movement and may be accompanied by decrease in heart rate or the child turning blue. After 30 to 45 seconds, the baby may also turn pale or limp and unresponsive to stimulation.
It is important to monitor all premature infants for apnoea for at least first few days of life. Prevention of low body temperature, low blood glucose levels, infection and avoiding events that precipitate apnoea such as nasopharyngeal suctioning can also help to prevent the onset of apnoea in premature infants.
A thorough physical examination should be carried out and investigations done to find out the cause for apnoea. These may include a full blood count, blood cultures, electrolytes and serum glucose levels as well as arterial blood gas measurement.
Treatment is recommended when the apnoeic spells are recurrent and prolonged or require resuscitation. It is important to identify and treat any underlying cause – such as placing the premature infant under a warmer, blood transfusion as necessary and treatment of hypoglycaemia. Some infants with obstructive or mixed apnoea require respiratory support such as Continuous Positive Airway Pressure (CPAP). Methylxanthine therapy (caffeine) has also been shown to reduce the number of apnoeic episodes. If such interventions fail, some infants require mechanical ventilation for persistent apnoea.