Learn About Apnea of Prematurity

What is the definition of Apnea of Prematurity?

Apnea means "without breath" and refers to breathing that slows down or stops from any cause. Apnea of prematurity refers to breathing pauses in babies who were born before 37 weeks of pregnancy (premature birth).

Most premature babies have some degree of apnea because the area of the brain that controls breathing is still developing.

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What are the alternative names for Apnea of Prematurity?

Apnea - newborns; AOP; As and Bs; A/B/D; Blue spell - newborns; Dusky spell - newborns; Spell - newborns; Apnea - neonatal

What are the causes of Apnea of Prematurity?

There are several reasons why newborns, in particular those who were born early, may have apnea, including:

  • The brain areas and nerve pathways that control breathing are still developing.
  • The muscles that keep the airway open are smaller and not as strong as they will be later in life.

Other stresses in a sick or premature baby may worsen apnea, including:

  • Anemia
  • Feeding problems
  • Heart or lung problems
  • Infection
  • Low oxygen levels
  • Temperature problems
What are the symptoms of Apnea of Prematurity?

The breathing pattern of newborns is not always regular and may be called "periodic breathing." This pattern is even more likely in newborns born early (preemies). It consists of short episodes (about 3 seconds) of either shallow breathing or stopped breathing (apnea). These episodes are followed by periods of regular breathing lasting 10 to 18 seconds.

Irregular breathing may be expected in less mature babies. But the pattern of breathing and the age of the baby are both important when deciding how sick the baby is.

Apnea episodes or "events" that last longer than 20 seconds are considered serious. The baby may also have a:

  • Drop in heart rate. This heart rate drop is called bradycardia (also called a "brady").
  • Drop in oxygen level (oxygen saturation). This is called desaturation (also called a "desat").
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What are the current treatments for Apnea of Prematurity?

How apnea is treated depends on:

  • The cause
  • How often it occurs
  • Severity of episodes

Babies who are otherwise healthy and have occasional minor episodes are simply watched. In these cases, the episodes go away when the babies are gently touched or "stimulated" during periods when breathing stops.

Babies who are well, but who are very premature and/or have many apnea episodes may be given caffeine. This will help make their breathing pattern more regular. Sometimes, the nurse will change a baby's position, use suction to remove fluid or mucus from the mouth or nose, or use a bag and mask to help with breathing.

Breathing can be assisted by:

  • Proper positioning
  • Slower feeding time
  • Oxygen
  • Continuous positive airway pressure (CPAP)
  • Breathing machine (ventilator) in extreme cases

Some infants who continue to have apnea but are otherwise mature and healthy may be discharged from the hospital on a home apnea monitor, with or without caffeine, until they have outgrown their immature breathing pattern.

Who are the top Apnea of Prematurity Local Doctors?
Highly rated in

Université Laval

Faculté De Médecine 
Quebec, QC, CA 

Aida Bairam is in Quebec, Canada. Bairam is rated as an Elite expert by MediFind in the treatment of Apnea of Prematurity. She is also highly rated in 3 other conditions, according to our data. Her top areas of expertise are Apnea of Prematurity, Infantile Apnea, Cerebral Hypoxia, and Oophorectomy.

Highly rated in

Université Laval

Faculté De Médecine 
Quebec, QC, CA 

Vincent Joseph is in Quebec, Canada. Joseph is rated as an Elite expert by MediFind in the treatment of Apnea of Prematurity. He is also highly rated in 5 other conditions, according to our data. His top areas of expertise are Apnea of Prematurity, Cerebral Hypoxia, Infantile Apnea, and Oophorectomy.

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Highly rated in

University Of Melbourne

Parkville, VIC, AU 

Lex Doyle is in Parkville, Australia. Doyle is rated as an Elite expert by MediFind in the treatment of Apnea of Prematurity. He is also highly rated in 22 other conditions, according to our data. His top areas of expertise are Premature Infant, Bronchopulmonary Dysplasia, Apnea of Prematurity, and Infantile Apnea.

What is the outlook (prognosis) for Apnea of Prematurity?

Apnea is common in premature babies. Mild apnea does not appear to have long-term effects. However, preventing multiple or severe episodes is better for the baby over the long-term.

Apnea of prematurity most often goes away as the baby approaches their "due date." In some cases, such as in infants who were born very prematurely or have severe lung disease, apnea may persist a few weeks longer.

What are the latest Apnea of Prematurity Clinical Trials?
Physiologic Biomarkers Predicting Ventilatory Instability and Hypoxemia in Pre Mature Infants
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Influence of Caffeine Therapy in Preterm Infants on Sleep and Neurodevelopmental Outcomes During the First Year of Life: a Single Center Experience
What are the Latest Advances for Apnea of Prematurity?
Effect of Prophylactic Caffeine on Noninvasive Respiratory Support in Preterm Neonates Weighing 1250-2000 g: A Randomized Controlled Trial.
Caffeine for the Treatment of Central Apnea in Trisomy 18: A Case Study in the Novel Use of Methylxanthines in Palliative Transport.
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Caffeine for the Treatment of Apnea in the Neonatal Intensive Care Unit: A Systematic Overview of Meta-Analyses.
Who are the sources who wrote this article ?

Published Date : January 15, 2021
Published By : Kimberly G. Lee, MD, MSc, IBCLC, Clinical Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What are the references for this article ?

Ahlfeld SK. Respiratory tract disorders. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KW, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 122.

Martin RJ. Pathophysiology of apnea of prematurity. In: Polin RA, Abman SH, Rowitch DH, Benitz WE, Fox WW, eds. Fetal and Neonatal Physiology. 5th ed. Philadelphia, PA: Elsevier; 2017:chap 157.

Patrinos ME. Neonatal apnea and the foundation of respiratory control. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 67.