Apnea of Prematurity

Condition 101

What is the definition of Apnea of Prematurity?

Apnea is breathing that slows down or stops from any cause. Apnea of prematurity refers to short episodes of stopped breathing in babies who were born before 37 weeks of pregnancy (premature birth).

Most premature babies have some degree of apnea.

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 for Apnea of Prematurity?

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

  • If their brain is not fully developed
  • If the muscles that keep the airway open are weak

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 for 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).

This irregular pattern is felt to be normal, but also thought of as immature.

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.

Apnea episodes 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 or, sometimes, a "brady."
  • Drop in oxygen level (oxygen saturation). This is called desaturation or, sometimes a "desat."

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 sometimes have few 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 will be discharged from the hospital on a home apnea monitor, with or without caffeine, until they have outgrown their immature breathing pattern.

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

Apnea is common in premature babies. Most babies have normal outcomes. 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, this may last as long as the 44th week, such as in infants who were born very prematurely.


Carlo WA, Ambalavanan N. Respiratory tract disorders. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 101.

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. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 75.

Latest Research

Latest Advance
  • Condition: Apnea of Prematurity (AOP) in Newborns
  • Journal: Pharmacology research & perspectives
  • Treatment Used: Caffeine Citrate
  • Number of Patients: 64
  • Published —
This study analyzed the effects of caffeine citrate on newborns with apnea of prematurity (temporary cessation of breathing, especially during sleep, due to immaturity of the central nervous system causing periods of rapid breathing followed by shallow or stopped breathing; AOP).
Latest Advance
  • Condition: Preterm Neonates with Apnea of Prematurity
  • Journal: Journal of perinatology : official journal of the California Perinatal Association
  • Treatment Used: Nasal Continuous Positive Airway Pressure (CPAP) vs. Noninvasive NAVA
  • Number of Patients: 17
  • Published —
This study compared clinically significant events for continuous positive airway pressure (CPAP) verus NAVA for preterm neonates with apnea (cessation of breathing) of prematurity.
Latest Advance
  • Condition: Preterm Infants
  • Journal: Pediatrics
  • Treatment Used: Caffeine
  • Number of Patients: 2108
  • Published —
This study tested the safety and efficacy of using an early caffeine exposure in preterm infants with less than 29 weeks of gestation to improve neurodevelopmental outcomes.

Clinical Trials

Clinical Trial
  • Status: Recruiting
  • Study Type: Drug
  • Participants: 398
  • Start Date: June 15, 2020
Doxapram Versus Placebo in Preterm Newborns: An International Double Blinded Multicenter Randomized Controlled Trial
Clinical Trial
  • Status: Recruiting
  • Study Type: Drug
  • Participants: 80
  • Start Date: April 1, 2019
High Versus Low Dose Caffeine as Respiratory Stimulant in Preterm Infants
Clinical Trial
  • Status: Recruiting
  • Study Type: Drug
  • Participants: 1200
  • Start Date: February 27, 2019
Randomized Controlled Trial of Home Therapy With Caffeine Citrate in Moderately Preterm Infants With Apnea of Prematurity
Clinical Trial
Diagnostic Test
  • Status: Recruiting
  • Study Type: Diagnostic Test
  • Participants: 375
  • Start Date: May 14, 2018
Physiologic Biomarkers Predicting Ventilatory Instability and Hypoxemia in Pre Mature Infants