Apnea of Prematurity

Once a baby is born, he or she needs to breathe continuously to get oxygen. In a premature baby, the part of the central nervous system (brain and spinal cord) that controls breathing is not yet mature enough to allow nonstop breathing. This causes large bursts of breath followed by periods of shallow breathing or stopped breathing. The medical term for this condition is apnea of prematurity, or AOP.

Apnea of prematurity is fairly common in preemies. Doctors usually diagnose the condition before the mother and baby are discharged from the hospital, and the apnea usually goes away on its own as the infant matures. Once apnea of prematurity goes away, it does not come back. But there's no doubt about it - it's frightening while it's happening.

What Is Apnea of Prematurity?

Apnea is a medical term that means a baby has stopped breathing. Most experts define apnea of prematurity as a condition in which premature infants stop breathing for 15 to 20 seconds during sleep.

Generally, babies who are born at less than 35 weeks' gestation have periods when they stop breathing or their heart rates drop. (The medical name for a slowed heart rate is bradycardia). These breathing abnormalities may begin after 2 days of life and last for up to 2 to 3 months after these premature infants are born. The lower the infant's weight and level of prematurity at birth, the more likely it is that the infant will have AOP spells.

Although it's normal for all infants to have pauses in breathing and heart rates, those with AOP have drops in heart rate below 80 beats per minute, which causes them to become pale or bluish. They may also appear limp, and their breathing may be noisy. They then either start breathing again by themselves or require help to resume breathing.

AOP may happen once a day or many times a day. Doctors will closely evaluate your infant to make sure the apnea isn't due to another condition, such as infection or internal bleeding.

Apnea of prematurity should not be confused with periodic breathing, which is also common in premature newborns. Periodic breathing is marked by a pause in breathing that lasts just a few seconds and is followed by several rapid and shallow breaths. Periodic breathing is not accompanied by a change in facial color (such as blueness around the mouth) or a drop in heart rate. A baby who has periodic breathing resumes regular breathing on his or her own.

Although it can be frightening, periodic breathing typically causes no other problems in newborns.

How Is Apnea of Prematurity Treated?

Most of the time, premature infants (especially those less than 34 weeks' gestation at birth) will receive medical care for apnea of prematurity in the hospital's neonatal intensive care unit (NICU). When they are first born, many of these premature infants must get help breathing from a ventilator because their lungs are too immature to allow them to breathe on their own.

During mechanical ventilation, a tube is placed into the baby's trachea (windpipe) and breaths of air are blown through the tube into the baby's lungs. These breaths are given at a set pressure. The ventilator is also programmed to give a certain number of breaths per minute, and the baby's breathing, heart rate, and oxygen levels are continuously monitored.