• Preterm babies have a very common problem with other conditions that may be related to or related to immaturity, and when it is observed in term babies, it is always considered to be pathological.
• Breathing pauses lasting more than 20 seconds or breathing that stops for any period of time with bradycardia or cyanosis are considered severe apnea. There is no bradycardia in convulsive apnea.
• Apnea of prematurity due to central immaturity is defined as apnea of prematurity.
Usually within the first week, 2nd-7th. occurs in days. Apnea appearing after the 2nd week should not be attributed to prematurity alone without eliminating other causes.
Apnea Types
1. Obstructive (12-20%)
2. Central (10-25%)
3. Mixed Apnea (50-75%)
Causes of Neonatal Apnea
Apnea treatment
• Tactical warning is usually sufficient in mild and intermittent apnea attacks.
• In recurrent or prolonged apnea attacks, aspiration, positioning and balloon-mask ventilation may be required.
• Theophylline or caffeine can be used in recurrent apnea of prematurity. Methyl xanthines act by decreasing the threshold response of the central respiratory center to hypercarbia, increasing the contractility of the diaphragm and reducing its fatigue. Caffeine is more effective than theophylline and has fewer side effects.
A 5-7 mg/kg loading dose of theophylline (oral) or aminophylline (IV) is followed by a maintenance dose of 1-2 mg/kg PO or IV every 6-12 hours. Caffeine is followed by a 20 mg/kg loading dose, followed by a 5 mg/kg/day PO or IV maintenance dose. Drug doses should be monitored by vital signs, clinical response, and drug blood levels (therapeutic levels: theophylline, 6-10 microg/mL; caffeine, 8-20 microg/ml). Caffeine may reduce the risk of bronchopulmonary dysplasia.
• Doxapram, which is a powerful respiratory stimulant and shows its effect mostly through peripheral chemoreceptors, has been used in the treatment of apnea of prematurity, has limited therapeutic importance due to its side effects.
• Nasal continuous positive airway pressure (CPAP at 3-5 cm Hp pressure} and high flow moistened nasal cannula (1-2.5 L/min) are effective methods in the treatment of mixed or obstructive apnea.CPAP works by supporting the upper airway and preventing airway obstruction .
• Available information does not support the relationship between gastroesophageal reflux and apnea attacks, or whether antireflux therapy reduces apnea attacks.
• In resistant apnea, the baby is intubated and monitored on a mechanical ventilator.
