Apnea of Prematurity

Apnea of prematurity is a breathing condition that affects babies born before 37 weeks gestation (preterm birth). Your baby’s body is still growing, and the parts that support breathing are still developing. So, your baby isn’t quite ready to breathe in a normal rhythm yet. Instead, they have periods where they don’t breathe (apnea). Providers call these periods apneic spells.

It can feel very scary to think your baby isn’t breathing right. But this condition is common among preterm babies. And providers know how to treat it. Your baby needs to spend some time in the neonatal intensive care unit (NICU). Providers monitor your baby’s vital signs and give them treatments to support breathing. Your baby can likely go home once they can breathe normally without treatments.

Symptoms of apnea of prematurity

Apnea of prematurity signs and symptoms include:

• Pauses in breathing that last 15 to 20 seconds or longer
• Slow heart rate (bradycardia)
• Low blood-oxygen level (hypoxemia), which can cause your baby’s skin to look blue, white, yellow-gray or gray — especially the lips and/or tongue (cyanosis)

Your baby may have breathing pauses that are shorter than 15 seconds. Providers consider these symptoms of apnea if they occur along with bradycardia and/or hypoxemia.

It’s important to distinguish these pauses from periodic breathing. Periodic breathing involves short pauses (less than 10 seconds) with no bradycardia or low oxygen level, followed by rapid breathing, and is considered normal.

Apnea of prematurity causes

Apnea of prematurity occurs because your baby’s airways and center for breathing in the brain aren’t fully developed yet. These parts of your baby’s body work together to allow them to breathe. Providers divide apnea in newborns into three main types according to what’s causing the breathing pauses:

• Obstructive
• Central
• Mixed

Obstructive apnea

This is when there’s a blockage in your baby’s airways. These passages carry oxygen-rich air into your baby’s lungs and remove carbon dioxide from their body. Your baby’s airways need to stay open wide enough to let air pass through.

But your baby’s airways (typically, the part that passes through their neck) may not be developed enough to stay open all the time. This can cause breathing pauses.

Central apnea

This is when your baby’s brainstem (the center in the brain responsible for breathing) doesn’t send out certain signals when expected. Normally, your baby’s brainstem sends signals to your baby’s respiratory muscles (like their diaphragm and intercostal muscles). These muscles help your baby’s lungs pull in and push out air so they can breathe.

But if your baby’s brainstem isn’t fully developed yet, it’s not ready to send out signals in a predictable or reliable way. This can lead to pauses in breathing.

Mixed apnea

This is when your baby’s airways and brainstem aren’t working as expected. It’s the most common type of apnea among preterm infants.

How doctors diagnose apnea of prematurity

Healthcare providers diagnose apnea of prematurity in the neonatal intensive care unit (NICU). This is an area of the hospital for babies who need extra care and medical attention. If your baby is born preterm, they may need to spend some time in the NICU before they can go home.

While your baby is in the NICU, providers monitor their:

• Heart rate
• Breathing
• Blood-oxygen level

Monitors go off if your baby’s heart rate drops or their breathing pauses for a certain amount of time. Data from these monitors — along with nurses’ observations — help providers diagnose apnea.

Apnea in newborns is sometimes a sign of other medical conditions. These include metabolic disorders, brain bleeds and infections. Providers check your baby for signs and symptoms of other medical conditions. They rule out all other causes before diagnosing your baby with apnea of prematurity.

An apnea of prematurity diagnosis means your baby’s breathing pauses are due to early birth. Their nervous system and respiratory system aren’t fully developed yet. So, your baby needs a little extra help with breathing until their body is ready to handle things on its own.

How is apnea of prematurity treated?

Apnea of prematurity treatment typically includes one or both of the following:

• Medications (usually caffeine citrate)
• Breathing support

Caffeine for apnea of prematurity

Caffeine citrate is a medication providers use to treat apnea of prematurity. Just like your morning coffee gives you a jolt, this medicine stimulates your baby’s nervous system. This “wake-up call” helps your baby’s brainstem and nerve cells send signals that regulate breathing.

Caffeine helps your baby have fewer apneic spells. It also helps shorten these pauses in breathing.

Breathing support

Your baby’s upper airway (pharynx and larynx) might need a little help staying open. If this is the case, providers often use continuous positive airway pressure (CPAP). With CPAP, your baby is still breathing on their own. But tiny prongs in their nose send air through their airway. This lowers the risk of breathing pauses from airway blockages.

If your baby continues to have severe apneic spells, they may need mechanical ventilation. This means a machine (a ventilator) does the work of breathing for your baby until their body can take over.

What can I expect if my newborn has apnea of prematurity?

Apnea of prematurity is a temporary condition. Symptoms improve as your baby grows. Your baby may need to spend several weeks — or even a couple of months — in the NICU. They’ll receive care not just for their breathing but also for any other issues related to preterm birth.

Providers will tell you how long your baby needs to stay in the NICU. They’ll also explain what needs to happen for your baby to safely head home.

In general, providers identify when it’s safe to stop giving your baby treatments. Then, after stopping treatment, they monitor your baby to see how their body responds. Your baby needs to go a certain number of days without apnea symptoms in order for providers to send them home. The length of this “observation period” depends on how early your baby was born and their overall health.

Most babies don’t need continued monitoring with devices at home. But if your baby does need monitoring, providers will explain exactly what’s involved. Ask if anything is unclear or you’re concerned about caring for your baby at home. Providers will make sure you get the information you need to feel comfortable with this transition.