What is neonatal apnea?

Neonatal apnea happens when a newborn baby pauses while breathing. These pauses can stop their breathing for 10 to 15 seconds or longer. The baby also has a rapid heart rate and a bluish tint to their skin. This is one of the more common conditions diagnosed in the neonatal intensive care units of hospitals. It's unclear whether neonatal apnea, even when it goes away and comes back, is harmful to the baby. Often, it's just a matter of the child developing their ability to control their breathing.

Types of neonatal apnea

The three main types of neonatal apnea include:

  • Central apnea - there's no signal going from the brain to the baby's diaphragm to make their lungs breathe.
  • Obstructive apnea - this can happen when the baby's pharynx collapses or when certain lung muscles are too weak.
  • Mixed apnea - a mixture of central and obstructive apnea.

Causes of neonatal apnea

Causes of neonatal apnea may include:

  • Premature birth
  • Heart or blood vessel problems
  • Immature nervous system
  • Bleeding or tissue damage in the brain
  • Respiratory disease

Risk factors for neonatal apnea

The most common cause of neonatal apnea is premature birth. Other risk factors that contribute to neonatal apnea include:

  • Infections
  • Poor temperature regulation
  • Mothers who are exposed to certain drugs before their babies are born
  • Other conditions like labored breathing or problems with heart functioning

Symptoms of neonatal apnea

Symptoms of neonatal apnea include:

  • Periods of absent breathing for 20 seconds or more
  • Rapid heartbeat
  • Blue coloring around the lips or nose
  • Severe decrease in heart rate (bradycardia)

Diagnosis of neonatal apnea

Once the baby shows symptoms, the doctor will try to determine the underlying cause. Diagnostic procedures may include:

  • Blood tests - these are done to check for blood counts, electrolyte levels, and infection.
  • Measurement of the levels of oxygen - the doctor will measure the amount of oxygen in the baby's body during an apnea episode.
  • Apnea study - a machine known as an "apnea monitor" can work as an alarm for any abnormal breathing patterns.

Treatments for neonatal apnea

Doctors first try to treat any underlying conditions that cause neonatal apnea. They often use a medicine called caffeine citrate. This drug relaxes smooth muscles, such as lungs. It also stimulates the baby's central nervous system and cardiac muscles to create breathing.

Other treatment options include:

  • Gently running the baby's feet during mild and intermittent breathing episodes
  • Positioning the baby to ensure their head and neck are in neutral positions so breathing is easier
  • Using suction to open the baby's airways. If this isn't effective, the baby may need to use a machine that puts air into their lungs until they breathe again

If these treatments don't work, doctors can use a high-flow nasal cannula. This device puts air through the baby's nostrils. A doctor may opt for a mechanical ventilation machine to breathe for the baby in more extreme cases.

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