APNEA IN THE NEWBORN

DEFINITION

Apnea is defined as cessation of respiration for

>20 sec or cessation of respiration of any duration accompanied by bradycardia (HR <100/min) and/or cyanosis

INCIDENCE AOP is related inversely to gestational age with 25% of preterm below 34 weeks needing either pharmacological or ventilator support for repeated apneic episodes

TYPES OF APNEA

Central

apnea(40%) apnea: (10%)

Obstructive Mixed

apnea: (50%)

CAUSES OF APNEA

APNEA OF

PREMATURITY
SECONDARY CAUSES

SECONDARY CAUSES
TEMPERATURE PROBLEMS

NEUROLOGICAL
PULMONARY CARDIAC

GASTRO-INTESTINAL HEMATOLOGICAL INFECTIONS METABOLIC

SYMPTOMS
Shallow Breathing Or Even Completely

Stop Breathing For Up To 10 Seconds

Bradycardia
Cyanosis

INVESTIGATIONS
Blood glucose,

Hematocrit,
Electrolytes, Septic screen, blood culture, Arterial blood gas, Chest x-ray, abdominal x-ray, Ultrasound

TREATMENT

Monitoring Movement sensors Thoracic impedence based

monitors Pulse oximeters

Emergency treatment
Checked for bradycardia, cyanosis and

airway obstruction. Neck should be positioned in slight extension Oro-pharynx gently suctioned and tactile stimulation Provide oxygen Ventilation with bag and mask Positive pressure ventilation

General measures: Maintain airway, breathing and circulation (ABC) Avoid vigorous suctioning of the oro-pharynx Avoid oral feeds for at least 24 hours. . Avoid swings in environmental temperature. Treatment of the underlying cause: sepsis, anemia, polycythemia, hypoglycemia, hypocalcemia, respiratory distress syndrome (RDS). Transfuse packed cells if hematocrit <30%.

SPECIFIC MEASURES
DRUGS INCLUDING AMINOPHYLLINE,

CAFFEINE, DOXAPRAM
PRESSURE (CPAP)

CONTINUOUS POSITIVE AIRWAY

MECHANICAL VENTILATION
KINESTHETIC STIMULATION: NO ROLE

Theophylline and Aminophylline

The loading dose of Aminophylline is 5-7

mg/kg administered IV followed by a maintenance dose of 1.5-2.0 mg/kg/dose Q68H given IV or PO. between 7-12 g/ml

Serum levels if available should be maintained

Caffeine
Alternative To Aminophylline The Loading Dose Is 10 Mg/Kg Iv Or

Po (20-mg/Kg Caffeine Citrate) Followed By A Maintenance Dose Of 2.5 Mg/Kg Od Iv or PO,

DOXAPRAM
Doxapram is associated with serious

side effects and hence should be used with caution or preferably avoided

PRESSURE
Continuous positive airway pressure (CPAP)

improves oxygenation, splints the upper airway during respiration and prevents collapse of the pharynx during expiration

 MECHANICAL VENTILATION KINESTHETIC STIMULATION