Apnea of Infancy Health Article

Apnea of Infancy

Cessation of an infant's normal breathing.

Apnea includes a temporary cessation of breathing, where breathing stops and begins again automatically after a few seconds, as well as a prolonged pause, where the baby must be resuscitated.

Apnea usually occurs during sleep and is primarily a disorder of premature infants. Babies born before 34 weeks of gestation do not have a fully developed central nervous system, and they often do not have adequate control of the breathing reflex. The more premature a baby is, the greater the likelihood of apnea. Episodes of apnea are also more problematic for smaller than for larger babies. A small baby stores a smaller amount of oxygen, so the effects of oxygen deprivation are more severe. Apnea usually appears within the first several days after the baby is born. Premature babies are usually kept in an incubator, where their breathing and heart rate are monitored. A drop in the baby's heart rate will sound an alarm, and a nurse can stimulate the baby to resume breathing, if necessary. If apnea is diagnosed, it will probably recur, but most premature babies outgrow the condition by the time they reach their normal due date.

Mild apnea causes no ill effects. The breathing pause is short (10-15 seconds), and the baby starts breathing again on his or her own. In a severe episode, though, breathing may cease for 20 seconds or longer. The infant begins to turn blue because of the lack of oxygen in the blood. The baby retains carbon dioxide and may lapse into unconsciousness unless stimulated to breathe. Rubbing the infant with a finger or striking the soles of the feet may be all that is needed to end a short episode of apnea. If the baby has become unconscious, however, he or she may need to be revived with an oxygen mask. If apnea is frequent or severe, the baby's doctor may decide to treat it by altering conditions in the incubator, such as lowering the temperature, increasing oxygen, or placing the infant in a rocking incubator. Blood transfusions and medication may also be necessary.

Premature babies are also at higher risk for "late apnea," which occurs when the infant is older than six weeks. Late apnea can also affect full-term babies and may be a sign of an underlying problem such as congenital heart disease, infection, anemia, meningitis, or seizures. The baby usually recovers from apnea as the underlying disease is treated. Even if no underlying cause is found, late apnea is usually outgrown by the time the baby turns one year old.

There are no specific measures to prevent apnea. It seems to be a sign of developmental immaturity, and it subsides as the baby grows older. Usually a premature baby in an incubator is continually monitored, and hospital staff can easily detect apnea. With late apnea, parents may not notice that the child has stopped breathing in his sleep. If apnea is suspected or diagnosed, parents may install a home monitor until the condition is outgrown. Undiagnosed late apnea can be fatal, and is associated with sudden infant death syndrome (SIDS). Parents of premature babies need to be apprised of the possibility of apnea, and should be instructed on how to resuscitate their infant if it occurs. Those particularly worried about late apnea may also wish to be trained in infant first aid. Since apnea usually occurs during sleep, parents may decide to sleep near the baby.

Books

Ince, Susan. Sleep Disturbance. Boston: Harvard Medical School, Health Publications Group, 1995.

Johnson, Thomas Scott. Phantom of the Night: Overcome Sleep Apnea Syndrome and Snoring —Win Your Hidden Struggle to Breathe, Sleep, and Live. New Technology Publishing, 1995.

Pascualy, Ralph A., and Sally Warren Soest. Snoring and Sleep Apnea: Personal and Family Guide to Diagnosis and Treatment. 2nd ed. New York: Demos Vermande, 1996.

Stradling, John R. Handbook of Sleep-related Breathing. New York: Oxford University Press, 1993.

Audiovisual Recordings

Getting a Good Night's Sleep. Cleveland, OH: Cleveland Clinic
Foundation, 1994.
(One two-hour videocassette. One of a series of seminars called "Health Talks at the Cleveland Clinic" developed by the Department of Patient Education, featuring Wallace Mendelson, M.D., Prakash Kotagal, M.D., Joseph Golish, M.D., Benjamin Wood, M.D.)

Sleep Disorders. Princeton, NJ: Films for the Humanities and Sciences, Inc., 1987.
(One 28-minute videocassette. Discusses sleep disorders and reviews cases of patients suffering from a variety of these disorders.)

—A. Woodward