Apnoea Of Prematurity

Apnoea of prematurity is cessation of breathing for more than 20 seconds, or a shorter pause associated with bradycardia, oxygen desaturation or cyanosis, in a preterm infant without another explanatory disease.

Immaturity of central respiratory control is the underlying mechanism.

Episodes may involve:

• Central apnoea
• Obstructive apnoea
• Mixed apnoea
• Bradycardia
• Desaturation
• Cyanosis

Any new or worsening apnoea requires exclusion of sepsis, hypoglycaemia, hypothermia, anaemia, seizures and intracranial pathology.

Diagnosis is one of exclusion.

Continuous cardiorespiratory and oxygen saturation monitoring is required in clinically significant disease.

• Gentle stimulation for brief episodes.

• Bag mask ventilation when spontaneous recovery is delayed or significant cyanosis develops.

• Caffeine citrate 20 mg/kg PO or IV loading dose, followed after 12 to 24 hours by 5 mg/kg once daily maintenance. Maintenance may be increased to 10 mg/kg/day for persistent episodes.

• Use CPAP when recurrent apnoea persists despite caffeine.

• Intubate and mechanically ventilate refractory severe disease.

Caffeine can generally be stopped once the infant has reached sufficient maturity and has remained free of significant episodes for several days.