What are the signs of apnea of prematurity, and what should I do if I notice them?

Apnea of prematurity is defined as a temporary cessation of breathing in infants born before 37 weeks of gestation [4]. This occurs due to the immature development of the breathing control centers in the brain and weak airway muscles [4]. If you notice a breathing pause lasting more than 20 seconds, or if it is accompanied by a drop in heart rate or oxygen levels, you must consult a doctor immediately.

Understanding Apnea of Prematurity vs. Periodic Breathing

Apnea of prematurity is common in premature infants; about 1 in every 10 infants born before 37 weeks of gestation experiences it [1]. It is important to distinguish this from "periodic breathing," a normal respiratory pattern in premature infants and even some full-term infants. Periodic breathing consists of short periods of shallow breathing or pauses lasting only a few seconds, followed by periods of regular breathing [4].

Episodes of apnea of prematurity are considered dangerous if they last longer than 20 seconds. During these episodes, additional signs may appear, such as a drop in heart rate (bradycardia) or a decrease in blood oxygen levels (hypoxia), which may present as skin discoloration to blue or pallor [4]. These signs require medical evaluation.

What to do when you notice an apnea episode?

If you notice a breathing pause in your premature infant, it is essential to act calmly and according to the instructions of the medical team. In some mild cases, doctors may recommend gentle stimulation of the infant, such as touching or stroking them gently, to help them restore their normal breathing pattern [4]. However, any aggressive or unadvised attempts that could harm the infant must be avoided.

In cases of recurrent or severe apnea, a doctor may prescribe medications such as caffeine to help regulate the breathing pattern [4]. Other treatments may include adjusting the infant's position, using suction to clear fluid or mucus from the nose or mouth, or, in extreme cases, using a ventilator [4].

Monitoring a Premature Infant at Home

All infants born before 35 weeks of gestation are admitted to Neonatal Intensive Care Units (NICUs) or special care nurseries with monitoring equipment, due to the high risk of apnea [4]. Some infants who continue to experience apnea but are otherwise mature and healthy may be discharged from the hospital with a home apnea monitor, with or without caffeine, until they outgrow this immature breathing pattern [4].

It is important to realize that home baby monitors are not the same as those used in hospitals. These devices may trigger false alarms for simple reasons such as the infant’s movement or bowel movements [4]. Therefore, the recordings from these devices should be regularly reviewed with your child's healthcare team. For more information on caring for a premature infant at home in general, you can visit Caring for a premature baby at home (Arabic).

When to consult a doctor?

You should always consult your child's physician if you notice any respiratory episodes, especially if they are frequent, prolonged, or accompanied by a change in the infant's skin color or a drop in heart rate [4]. The severity of apnea episodes may be affected by other factors such as anemia, infection, heart or lung problems, feeding issues, low oxygen levels, or temperature problems [4]. A comprehensive medical assessment is necessary to identify the root cause and establish an appropriate treatment plan.

In most cases, apnea of prematurity disappears as the infant approaches their original due date, as their respiratory and nervous systems mature sufficiently to support continuous and stable breathing [4]. However, in some cases, such as infants born very early or those with severe lung disease, apnea may persist for a few weeks longer [4].

Medical references

• Apnea of prematurity: MedlinePlus Medical Encyclopedia
• Premature Babies