Apnea of prematurity

Apnea of prematurity is defined as respiratory pauses of more than 20 s, or interruption of air flow and respiratory pauses of less than 20 s combined with bradycardia (less than 80 beats / min), central cyanosis or O2 saturation of less than 85% in children born less than 37 weeks gestation, and in the absence of causes that cause apnea. The causes of apnea of prematurity may be immaturity of the central nervous system (CNS) or airway obstruction.

The diagnosis is made for multichannel respiratory monitoring. Treatment is carried out by respiratory stimulants with central apnea and proper placement of the head in obstructive apnea. The outlook is favorable; Apnea is discontinued in most newborns by 37 weeks.

About 25% of premature babies have apnea of prematurity, which usually begin 2-3 days after birth and very rarely on the first day; apnea, which develops more than 14 days after birth in a child healthy otherwise, means a serious illness other than apnea of prematurity. The greater the risk, the less gestational age.

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Causes of apnea of prematurity

Apnea of prematurity may be central, obstructive, or a combination of these; a mixed species is found most often. Central apnea is caused by the immaturity of the respiratory centers in the medulla oblongata; insufficient nerve impulses from the respiratory centers reach the respiratory muscles, and the baby stops breathing. Hypoxemia briefly stimulates breathing, but after a few seconds depresses it. Obstructive sleep apnea is caused by obstruction of the airways or when bending the neck causing compression of the hypopharyngeal soft tissues, or disturbing the nasal breathing. Both types of apnea can cause hypoxemia, cyanosis, bradycardia, if apnea is prolonged. Among the children who died from IFOR, 18% had a history of prematurity, but the apnea of prematurity did not appear to be a precursor to IFS.

[4], [5], [6], [7], [8], [9]

Diagnosis of apnea of prematurity

By itself, the diagnosis of apnea is made by chance on the basis of monitoring the child, but children from the high-risk group use an apnea monitor that is connected for 5-7 days. Typical monitors have a ribbon around the chest to determine its movements and a pulse oximeter to determine heart rate and oxygen saturation; Nasal breathing should also be monitored if obstructive sleep apnea is suspected. Apnea of prematurity is the diagnosis of an exception. Other causes of apnea in newborns include hypoglycemia, hypocalcemia, sepsis, intracranial hemorrhage and gastroesophageal reflux; these causes are identified by appropriate examination.

Children from high-risk groups who do not have apnea and who are already ready for discharge may continue to monitor the home. Parents should be taught how to locate the belt and wires; how to interpret the significance of alarm signals, assessing the skin color of the child and his breathing; how to help the child if necessary. They should also be instructed on how to keep a diary of alarms and how to contact health professionals if there are any questions or the child will have episodes of apnea. Many monitors keep information, allowing healthcare professionals to evaluate the type and frequency of episodes, compare them to those reported and recorded in the parents' diary, and determine whether you need another treatment, or you can remove the monitor.

[10], [11], [12]

Treatment of apnea of prematurity

The head of the child should be located on the middle line, and the neck - in a neutral position or be slightly bent to avoid obstruction of the upper respiratory tract. All premature infants, especially those with apnea of prematurity, are at high risk for apnea, bradycardia and O2 desaturation while in the car seat, so they must undergo a test in the car seat before discharge.

If apnea is observed, either during observation of the baby or at a monitor signal, the child's irritation should be carried out, this may be sufficient; if breathing is not restored, an artificial ventilation is provided for the bag of the valve or mouth in the mouth and nose. If the children are at home, the doctor should be contacted if there is an apnea that disappeared with irritation; If other types of intervention are required, the child should be re-hospitalized and examined.

Respiratory stimulators are indicated for frequent or severe episodes characterized by hypoxemia, cyanosis, and / or bradycardia. Caffeine is the safest and most commonly used drug. It can be given as a base (initial dose of 10 mg / kg, then a maintenance dose of 2.5 mg / kg orally after 24 hours) or citrate, a caffeine salt containing 50% caffeine (an initial dose of 20 mg / kg, then maintaining 5 mg / kg after 24 hours). Other possibilities include intravenous administration of methylxanthines [euphyllin - the initial dose is 6-7 mg / kg for 20 minutes, followed by a maintenance dose of 1-3 mg / kg in 8-12 hours (less in younger, premature babies) or theophylline - initial the dose is 4-5 mg / kg, then maintaining a dose of 1-2 mg / kg after 8-12 hours], the dosages of these drugs are corrected to maintain the level of theophylline in the blood of 6-12 μg / ml, and doxapram [0.5-2 , 0 mg / (kg x hour) long-term intravenous infusion]. Treatment continues until the newborn reaches the age of 34-35 weeks of gestation and has at least five to seven days' absence of apnea requiring intervention. Monitoring is continued until at least 5-10 days later there is no apnea requiring intervention.

If the apnea continues, in spite of the stimulants of respiration, the newborn can be transferred to the SDPD, starting at a pressure of 5-8 cm of water. Unremovable episodes of apnea require ventilation of the lungs. The issue of a child's discharge is decided by many people differently; some doctors observe the child 7 days after the end of treatment to make sure that apnea or bradycardia do not recur while others prescribe children against the theophylline treatment if treatment is effective.

Prognosis of apnea of prematurity

In most premature infants, episodes of apnea stop by the time they reach about 37 weeks of gestation; Apnea can last for weeks in children who were born at extremely early times (23-27 weeks). Mortality after apnea of prematurity is low and does not depend on treatment.