Apnoea

Apnoea is a pause in breathing for more than 20 seconds often accompanied by low heart rate or low oxygen in the blood. It is common in premature babies and mainly occurs in infants born at less than 34 weeks.

Apnoea may be due to:

• Immaturity of the brain and, in particular, the respiratory centre.
• Weakness of the respiratory muscles.
• Failure to keep the airways open.

Apnoea may be the result of:

• Immaturity
• Anaemia
• Gastro-oesophageal reflux
• Heart or lung problems
• Infection
• Neurological problems e.g. seizures

Management of Apnoea

How apnoea is treated depends on the cause, frequency and its severity:

1. Babies who appear to be otherwise healthy and have few episodes per day are simply watched. They can be gently stimulated with a gentle tap to the sole of the foot or rubbing the back during their occasional episodes. Repositioning the baby’s head and neck or gently elevating the infant's jaw may reduce the frequency and severity of episodes.

2. Those who are well, but who have frequent episodes in which they stop breathing may be given a caffeine preparation to help stimulate their breathing. At times they may need suctioning, change of position, or use of a bag and mask to help them breathe.

3. Severe cases require oxygen and in more extreme cases a breathing machine (ventilator) to assist in breathing.

Prognosis

Apnoea of prematurity is a self-limiting condition that will resolve with increasing maturity; it usually goes away by the baby’s 36th week. Most babies have normal outcomes. It is difficult to predict the exact impact of apnoea. It is known however that frequent and severe apnoea may adversely affect neurological development.

Home Apnoea Monitoring

Home apnoea monitors (which must be distinguished from infant monitors that are designed only to allow parents to listen to the sounds a baby makes) measure respiratory movements. If the baby stops breathing the monitor sounds an alarm. The monitor is usually connected to the baby by a soft belt that goes around his/her chest. There are also special apnoea mattresses that monitor breathing movements. The recorded data from these devices can alert parents if a baby stops breathing and may help the doctors to evaluate whether further treatment/monitoring is required.

Home monitoring may be indicated in:

• History of significant apnoea (e.g. due to bronchopulmonary dysplasia, cardiac disease or neurological problems) whose monitoring was unstable in hospital
• Feeding difficulties with apnoea
• Increased risk from Sudden infant death syndrome (SIDS) e.g. family history

The duration of home monitoring is variable; typically it is required for 6-12 weeks after discharge. Monitoring beyond age 1 year is uncommon. Studies have not been able to show a benefit of putting babies on home monitors, so these monitors are rarely prescribed. These devices are readily available for sale to the public, so it must be recognised that they may be used by carers as a matter of personal preference rather than being medically prescribed.

Unless accompanied by other therapeutic requirements such as home oxygen, apnoea monitoring does not significantly result in increased care/supervision requirements.