Learn About 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.
Apnea - newborns; AOP; As and Bs; A/B/D; Blue spell - newborns; Dusky spell - newborns; Spell - newborns; Apnea - neonatal
There are several reasons why newborns, especially those who were born early (prematurely), 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
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. It consists of episodes of either shallow breathing or short pauses in breathing lasting just a few seconds. These episodes are then followed by periods of regular breathing. This is generally considered a normal pattern and can be expected in less mature and even some full-term babies. However, the pattern of breathing, length of breathing pauses, and the age of the baby are both important when deciding if it needs to be further evaluated.
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").
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 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.
Richard Martin is a Neonatologist and a Pediatrics provider in Cleveland, Ohio. Dr. Martin is rated as an Elite provider by MediFind in the treatment of Apnea of Prematurity. His top areas of expertise are Apnea of Prematurity, Infantile Apnea, Premature Infant, Cerebral Hypoxia, and Endoscopy. Dr. Martin is currently accepting new patients.
Barbara Schmidt practices in Adelaide, Australia. Ms. Schmidt is rated as an Elite expert by MediFind in the treatment of Apnea of Prematurity. Her top areas of expertise are Apnea of Prematurity, Infantile Apnea, Premature Infant, Bronchopulmonary Dysplasia, and Adenoidectomy.
Lex Doyle practices in Parkville, Australia. Mr. Doyle is rated as an Elite expert by MediFind in the treatment of Apnea of Prematurity. His top areas of expertise are Premature Infant, Apnea of Prematurity, Bronchopulmonary Dysplasia, and Infantile Apnea.
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.
Summary: This study aims to assess whether extending the duration of caffeine therapy will help preterm infants achieve full oral feeding faster.
Summary: Diagnostic investigations in paediatric respiratory and sleep medicine are often challenging due to patient size (due to prematurity), tolerability, and compliance with gold standard equipment. Children with sensory/behavioural issues, at increased risk of sleep disordered breathing (SDB), often find tolerating standard diagnostic equipment difficult. There is a need to develop non-invasive, wirel...
Published Date: January 15, 2025
Published By: Mary J. Terrell, MD, IBCLC, Neonatologist, Cape Fear Valley Medical Center, Fayetteville, NC. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Mitchell LJ, Macfarlane PM, Bavis RW, Martin RJ. Pathophysiology of apnea of prematurity. In: Polin RA, Abman SH, Rowitch DH, Benitz WE, Fox WW, eds. Fetal and Neonatal Physiology. 6th ed. Philadelphia, PA: Elsevier; 2022:chap 156.
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.
Sprecher AJ, Acharya KK, Cohen SS. Apnea. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 125.