Management of apnea of prematurity
- Richard Martin, MD
Richard Martin, MD
- Section Editor — Neonatology
- Professor, Pediatrics, Reproductive Biology, and Physiology & Biophysics
- Case Western Reserve University School of Medicine
- Section Editors
- Joseph A Garcia-Prats, MD
Joseph A Garcia-Prats, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
- George B Mallory, MD
George B Mallory, MD
- Section Editor — Pediatric Pulmonology
- Associate Professor of Pediatrics
- Baylor College of Medicine
Apnea of prematurity is a developmental disorder in preterm infants, which occurs as a direct consequence of immature respiratory control. In an infant less than 37 weeks gestational age (GA), apneic spells are considered clinically significant if the episodes are greater than 20-second duration or when shorter episodes are accompanied by hypoxemia and/or bradycardia . The frequency and severity of symptoms is inversely proportional to GA, and almost all extremely low birth weight (ELBW) infants (BW below 1000 g) are affected.
The management of apnea of prematurity will be reviewed here. The pathogenesis, clinical features, and diagnosis of apnea of prematurity are discussed separately. (See "Pathogenesis, clinical presentation, and diagnosis of apnea of prematurity".)
Preterm infants with a gestational age (GA) less than 35 weeks should be monitored for apnea because of the high prevalence of apnea in this group of patients. In most neonatal intensive care units (NICUs), cardiac monitors, pulse oximeters, and impedance pneumography are used to monitor for apnea of prematurity and its associated bradycardia and hypoxemia. The accuracy of pneumography is limited by movement artifacts and the inability to detect obstructive apnea episodes, and is generally not used as the sole technique. (See "Pathogenesis, clinical presentation, and diagnosis of apnea of prematurity", section on 'Incidence' and "Oxygen monitoring and therapy in the newborn" and "Oxygen monitoring and therapy in the newborn", section on 'Pulse oximetry'.)
There are no data on the optimal threshold settings to determine significant apnea events. In our practice, we use the following threshold settings to detect episodes of apnea and its associated bradycardia and hypoxemia. The lower thresholds are used when the decision is being made to discontinue caffeine therapy or discharge the infant home. Other centers utilize different parameters.
●Apnea ≥15 or 20 seconds
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- MANAGEMENT OVERVIEW
- GENERAL MEASURES
- NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE
- NASAL INTERMITTENT POSITIVE PRESSURE VENTILATION
- METHYLXANTHINE THERAPY
- - Prophylactic use
- Mechanism of action
- Side effects
- Caffeine versus theophylline
- Therapeutic caffeine
- - Indications
- - Initial and maintenance dosing
- - Discontinuation of caffeine
- - Response failure
- OTHER THERAPIES
- Possible role of transfusion
- PERSISTENT APNEA
- DISCHARGE PLANNING
- SUMMARY AND RECOMMENDATIONS