Apnea of Prematurity (continued)

Sometimes babies with apnea of prematurity are given medications to help mature their lungs and allow the preemies to come off mechanical ventilation within a few weeks and breathe on their own.

When infants are disconnected from a mechanical ventilator, often they require a form of assisted breathing called nasal continuous positive airway pressure (CPAP). A nasal CPAP device consists of a large tube with tiny prongs that fit into the baby's nose, which is hooked to a machine that provides oxygenated air into the baby's air passages and lungs. The pressure from the CPAP machine helps keep a preemie's lungs open so he or she can breathe. However, the machine does not provide breaths for the baby, so the baby breathes on his or her own.

Once preemies are off a mechanical ventilator and breathing on their own - with or without nasal CPAP - they are monitored continuously for any evidence of apnea. The cardiorespiratory monitor (also known as an apnea and bradycardia, or A/B, monitor) also tracks the infant's heart rate. An alarm on the monitor sounds if there's no breath for a set number of seconds. When the monitor sounds, a nurse immediately checks the baby for signs of distress. False alarms are not uncommon.

If a baby doesn't begin to breathe again within 15 seconds, a nurse will rub the baby's back, arms, or legs to stimulate the breathing. Most of the time, babies with apnea of prematurity spells will begin breathing again on their own with this kind of stimulation.

However, if the nurse handles the baby, and the baby still hasn't begun breathing on his or her own and the baby becomes pale or bluish in color, oxygen may be administered with a handheld bag and mask. The nurse or doctor will place the mask over the infant's face and use the bag to slowly pump a few breaths into the baby's lungs. Usually only a few breaths are needed before the baby begins to breathe again on his or her own.

If a baby begins to have many such apnea spells, medication is sometimes given intravenously or by mouth to stimulate the part of the brain that controls breathing. This often reduces the apnea spells.

When Your Baby Is on a Home Apnea Monitor

Although apnea spells are usually resolved by the time most preemies go home, a few will continue to have apnea spells. In these cases, if the doctor thinks it's necessary, the baby will be discharged from the NICU with an apnea monitor.

An apnea monitor consists of two main parts: a belt with sensory wires that your child wears around his or her chest and a monitoring unit with an alarm. The sensors measure the baby's chest movement and breathing rate while the monitor continuously records these rates. Before the baby leaves the hospital, the NICU staff will thoroughly review the monitor with you and give you detailed instructions on how and when to use it, as well as how to respond to an alarm. Parents and caregivers will also be trained in infant CPR, even though it's unlikely they'll ever have to use it.

If the baby isn't breathing when you check him or her or your baby's face seems pale or bluish, follow the instructions given to you by the NICU staff. Usually, your response will involve some gentle stimulation techniques and, if these don't work, starting CPR and calling 911. Remember, never shake your baby to wake him or her.