Apnoea of Prematurity

Last updated 20.09.12

Index

Definition

- Nil effective resp effort for 20sec or less if ass w bradycardia (<100), cyanosis or pallor

- Central: complete cessation of chest movement

- Obstructive: pause secondary to obstruction, with attempted resp efforts

- Mixed

Features

- Dx of exclusion in <34 weeks premature infants

- Not a risk factor for SIDS

- Apnoea on day 1 is NOT normal

- Incidence

- <30 weeks most infants

- 30-32 weeks 50%

- 32-34 weeks 10%

- Usually resolves by 36 weeks CA

- Central

- 10-15% all apnoeas

- May be provoked by vagal stimulation (oral or nasal suction, NGT)

- Obstructive

- 10-15% all apnoeas

- Mixed

- 50-75% all apnoeas

DDx

- Periodic breathing: resp pauses >3 sec + <20 sec respiration between pauses

Causes of Apnoea in Infants

- Day 1-2: sepsis, hypoglycaemia, impending resp failure, polycythemia

- Day 3-6: sepsis, impending resp failure, PDA, massive IVH, apnoea of prematurity

Ix

- O2Sats

- BSL

- CRP, FBE

- +/- BC

Mx

- Cardiorespiratory monitor

- Apnoea monitor

- Mx of apnoea

- Caffeine IV

- Loading dose 20mg/kg Daily --> maintenance 5mg/kg Daily

- Ceased once apnoea fee for 1-2 weeks+ & >34 weeks CA

- Monitor for 1/52 post ceases

References