Apnea of prematurity is a temporary stop in breathing in infants. It usually lasts 15-20 seconds, but can also be diagnosed if less than 15 seconds when a slowed heart rhythm or other symptoms occur. It is most common in premature infants, but can rarely occur in full term infants as well. In general, the more premature the infants the more likely apnea will happen.
Apnea may be caused by problems with the nervous system, weak muscles in the airway, or a combination of both.
Breathing is controlled by the brain. The brain should both sense the need for increased breathing and stimulate the body to breathe. Immature nervous systems, like those in premature infants, may not be able to do these functions well. This type of apnea is known as central apnea.
Premature infants may also have weak muscles around the airway. The muscles cannot properly support the airway and keep it open, making breathing difficult. This type of apnea is known as obstructive apnea.
Certain medications, such as opioids, prostaglandin, and magnesium sulfate, can also suppress the body’s urge to breathe.
Factors that increase the chance of apnea of prematurity may include:
Factors that may worsen the apnea include:
Symptoms occur in the first week of life. Symptoms may include:
Breathing and heart rates are monitored in most premature babies for at least the first few days.
At the initial onset of apnea:
The doctor will measure chest movements and nasal air flow at the same time. This can help determine if central apnea, obstructive apnea, or a combination of both are present.
Apnea of prematurity will go away on its own as the infant approaches what would have been the 36th week of gestation.
Treatment may be needed until the apnea resolves. Options will depend on how frequent and severe the apnea episodes are and the infant’s overall health. Most premature infants will be hospitalized during the time that apnea is present. Part of care will include heart rate and breathing monitoring. The monitors will sound an alarm when abnormal breathing is present.
Rubbing or patting the baby during an episode can stimulate breathing to start again. Infants with mild and infrequent episodes can simply be monitored and stimulated when needed. More frequent episodes may require:
A continuous positive airway pressure (CPAP) machine can help take over breathing if there is a long pause. This machine provides gentle pressure in the airways to help keep airways open and provide oxygen.
Other steps that may help decrease the frequency of episodes include:
Parents and caregivers should be trained to administer CPR in the event of an emergency.
There is no known way to prevent apnea of prematurity. Since the apnea is related to prematurity, decreasing the risk of premature birth may help. Some cases of premature birth may be prevented with early and proper prenatal care, and good health of the mother during pregnancy. General tips for a healthy pregnancy include:
Healthy Children—American Academy of Pediatrics
Kids Health—Nemours Foundation
Caring for Kids—Canadian Paediatric Society
Apnea in premature infants. Children’s Healthcare of Atlanta website. Available at: http://www.choa.org/Childrens-Hospital-Services/Pulmonology/Apnea/Apnea-of-Prematurity. Accessed May 4, 2016.
Apnea of prematurity. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114149/Apnea-of-prematurity. Updated January 22, 2016. Accessed October 3, 2016.
Apnea of prematurity. Johns Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/healthlibrary/conditions/adult/pediatrics/apnea_of_prematurity_22,ApneaOfPrematurity. Accessed May 4, 2016.
Apnea of prematurity. Nemours Kids Health website. Available at: http://kidshealth.org/en/parents/aop.html. Updated October 2014. Accessed May 4, 2016.
Apnea of prematurity. University of Rochester Medical Center website. Available at: https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02922. Accessed May 4, 2016.
Last reviewed May 2016 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.