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Apnea (temporary cessation of breathing) in premature infants

Babies need to breathe constantly to get oxygen. In a premature baby, the part of the central nervous system (brain and spinal cord) that controls breathing is not yet properly developed. Apnea of prematurity is one of the most common diagnoses in the hospital neonatal intensive care unit. With apnea, breathing stops temporarily. Most premature and some sick full-term infants have some degree of apnea. A slower heart rate and reduced oxygen levels in the blood are other symptoms of temporarily stopped breathing. Thorough monitoring in combination with medications, stimulation and some other tips are possible treatment options. This frightening situation almost always disappears as a child grows older.

  • Definition of apnea
  • Classification of arrested breathing in premature babies
  • Epidemiology
  • Causes of temporary stopped breathing in premature infants
  • Symptoms: Slow heart rate and drop in oxygen levels
  • Diagnosis and examinations
  • Treatment: Medicines, stimulation and oxygen
  • Prognosis of temporary cessation of breathing is excellent


Definition of apnea

Apnea is a cessation of breathing for twenty seconds or more, or a brief pause associated with a slowed heart rate (<100 beats per minute), cyanosis (cyanosis of the skin and mucous membranes), or pallor. In practice, many apnea episodes in premature infants are shorter than twenty seconds, because shorter pauses in airflow lead to bradycardia (a slowed heart rate) or hypoxemia (lack of oxygen in the blood).

Classification of arrested breathing in premature babies

Based on breathing effort and air flow, apnea can be classified as central (breathing arrest after exertion), obstructive (blockage of the airway, usually involving the pharynx) or mixed . The majority of apnea episodes in preterm infants are mixed events, in which the blocked airflow results in a central apnea pause or vice versa.


Almost all babies born at less than 35 weeks’ gestation have periods where they stop breathing or where their heart rate drops. There is no racial, sexual or geographical preference.

Causes of temporary stopped breathing in premature infants

Premature newborns may have apnea for a variety of reasons. This happens when the brain is not fully developed, or when the muscles that keep the airways open are weakened.

Symptoms: Slow heart rate and drop in oxygen levels

The breathing pattern of newborns is not always regular and is therefore known as “periodic breathing”. This pattern is even more accentuated in premature babies. The patient breathes very shallowly or sometimes not at all for about three seconds. This is followed by a period of regular breathing that lasts for ten to eighteen seconds. He then enters an apnea phase again where he breathes superficially or not at all. Sometimes an apnea episode happens for more than twenty seconds, which is serious. In addition, the heart rate may slow down (bradycardia) or a drop in oxygen levels (hypoxemia) may occur.Other factors aggravate apnea in premature babies:

  • anemia (anemia)
  • an infection
  • a low oxygen level
  • heart or lung problems
  • temperature problems
  • nutritional problems


Diagnosis and examinations

Physical and diagnostic examination

The doctor monitors these premature babies via a monitor. On this he reads breathing, heart rate and oxygen levels. The alarm goes off in case of apnea, a drop in heart rate or low oxygen levels. Measuring oxygen saturation is possible thanks to pulse oximetry. A drop in heart rate and oxygen levels occurs not only with apnea, but sometimes also when passing or moving stool.

Differential diagnosis

Some conditions resemble the clinical picture of apnea in premature infants, including:

  • respiratory failure (severe illness with slow breathing)
  • anemia (anemia) in premature infants
  • a respiratory syncytial virus infection (RSV: viral infection with respiratory symptoms)
  • neonatal sepsis (blood poisoning in babies)


Treatment: Medicines, stimulation and oxygen

Treatment for apnea depends on the cause, how often breathing stops, and the severity of the episodes. Babies who are otherwise healthy and suffer from apnea episodes only a few times a day are given expectant treatment, with the doctor sometimes gently shaking the patient when breathing has stopped. If the baby is healthy and has many episodes of stopping breathing, he is given caffeine. This stimulates breathing. Sometimes the doctor or nurse changes the position of a baby, or he or she suctions fluid or mucus from the mouth or nose, or gives the premature baby a breathing mask. Proper positioning, a slower feeding time, oxygen, medications and (in extreme cases) a respirator will help with breathing. If premature babies still suffer from apnea despite the treatments, they can go home after treatment with an apnea monitor. They may still receive caffeine until the patient has outgrown the immature breathing pattern. The doctor also treats any possible underlying medical problems or conditions in the infant.

Prognosis of temporary cessation of breathing is excellent

Apnea is common in premature babies. Most babies have good prospects. Mild apnea is basically not serious and has no long-term effects. However, multiple or severe episodes are often less beneficial in the long term because they are often accompanied by underlying heart or lung conditions. The symptoms often disappear when the baby is between 36 and 44 weeks old from conception.