Research into the development of respiratory control in immature animals and preterm infants has facilitated our understanding of the pathogenesis and treatment of apnea of. Apnea can be an expected complication of prematurity, or it can be the first sign of a lifethreatening disorder, such as sepsis or pulmonary disease. Neonatal resource services apnea and bradycardia medical necessity guideline purpose. The length of time necessary to be qualified as a true apneic event has changed dramatically over the last few decades. The apnea of the preterm infant is one of the most common problems in the neonatal intensive care unit and has a complex physiopa. Guideline update american academy of sleep medicine.
Pathogenesis and management of apnea of prematurity. Apnea of prematurity american academy of pediatrics. Apnea of prematurity, defined as cessation of breathing for 20 seconds, is extremely common among premature infants born. Neonatal nursing is an exciting field in which research is driving evidencebased medical and nursing care. Apnea of prematurity is one of the most common diagnoses in the nicu. Apnea of prematurity is a diagnosis of exclusion because many conditions during the neonatal period can lead to cessation of respiration. Staphylococci account for 30 to 60% of lateonset cases and are most frequently due to intravascular devices particularly central vascular catheters. Comparison between aap recommended levels of neonatal care 2007 vs. The duration of obstructive and mixed apneas also tended to decrease with age. The infant apnea clinic is a resource for parents using a home apnea monitor for their infant or child. Management of neonatal apnea university of iowa stead.
Apnea may be classified as obstructive, central, or mixed. Apnea of prematurity treatment and guidelines medical. Clinical performance guideline neonatal resource services. As a compromise, the 30second timepointhasbeenremoved. Apnea in the neonatal period american academy of pediatrics. Apnea of prematurity aop is a common problem affecting premature infants, likely secondary to a physiologic immaturity of respiratory control that may be exacerbated by neonatal disease. Numerous factors are likely to play a role in the etiology of apnea. Out of a total 63 newborns who survived until 1 year of age, 32 presented apnea at some point and that required treatment, and 10 presented severe and recurring apnea. Clinical performance guideline medical neonatal resource.
Averys diseases of the newborn, edited by christine a. Alere neonatal clinical management guidelines 8th edition. Herein authors present a case of neonatal autonomic apnea, discussing the polygraphic videoeeg features of this pathological entity and the. To provide guidelines to determine the optimal course of treatment and subsequent case management of the neonate with neonatal apnea. The most common cause of apnea in the neonatal intensive care unit is apnea of prematurity, but it is necessary to initially investigate and rule out the following disorders. These include altered ventilatory responses to hypoxia, hypercapnia, and altered sleep states, while the roles of gastroesophageal reflux and anemia remain. Additionally, sleep disordered breathing had to be clearly differentiated between csas and osa.
These infants exhibit various combinations of apnea, bradycardia, and oxygen desaturation. Methylxanthines are effective in treating aop see chapter 3. The average weight of newborns with apnea was of 1,124 g, whereas in those without. Including selected updates of contemporary issues concerning basic research and clinical practice, the present book investigates pathogenetic mechanisms implicated in fetal brain injury, sleep apnea, as well as covering the field of neonatal gastroenterology and nutrition care. For this reason, guidelines have changed enormously during the last 20 years. Periodic breathing is a normal event, is usually not associated. An important but underrecognized issue for all countries is that of disability for survivors of preterm birth see chapter 2. Apnea of prematurity is a developmental disorder that frequently affects preterm infants, especially those with lower gestational age. Longterm effects of caffeine therapy for apnea of prematurity. Aop is a common diagnosis in the neonatal intensive care unit and one of. Risk factors, symptoms, and management of common conditions will be discussed. Common concerns for which a home monitor is used include.
Director, newborn services, university of virginia school of medicine, charlottesville neonatal apnea is a disorder with many possible etiologies and a wide range of severity. The most common cause of apnea in the nicu is apnea of prematurity. Move on toward new frontiers today and be prepared for the developments of tomorrow. Pdf on aug 1, 2012, roy k philip and others published caffeine and neonatal apnea find, read and cite all the research you need on researchgate. An approach to the management of apnea in neonates is described.
In the early days of neonatal intensive care, disabilities. Apnea, especially in preterm newborns aop is one of the common problems encountered at neonatal units. Kim has created and presented programs for neonatal assess ment, management, and neonatal conditions. Survival without disability to age 5 years after neonatal caffeine therapy for apnea of prematurity. Despite the frequency of apnea of prematurity, it is unknown whether recurrent apnea, bradycardia, and hypoxemia in preterm infants are harmful. Apnea is defined by the cessation of respiratory airflow. Sepsis especially in the first day of life and nosocomial infections andor necrotizing enterocolitis in the first weeks of life. Apnea of prematurity aop is a common disorder in premature infants born before 34 weeks gestation. Apnea and bradycardia ucsf benioff childrens hospital. This uptotheminute work is set against the backdrop of remarkable advances in neonatal care. Medical necessity guideline clinical performance guideline neonatal resource services apnea and bradycardia purposegoal.
Labored breathing cyanosis positivepressure ventilation spo2 monitoring hr below 100. The frequency of central apnea decreases with age, but the duration was steady at around 35 seconds across all age groups. Pediatric apnea differential diagnoses medscape reference. Devaskar, is a practical, clinical reference for diagnosing and managing of all the important diseases affecting newborns. Complex sleep apnea was not included, as it is not currently listed as a disorder in the icsd2. Lateonset neonatal sepsis is usually acquired from the environment see neonatal hospitalacquired infection. Introduction about 3045% of preterm babies exhibit a periodic breathing pattern characterized by 3 or more respiratory pauses of greater than 3 seconds duration with less than 20 seconds respiration between pauses. Comparison between aap recommended levels of neonatal. When your baby has trouble breathing or has a form of apnea, which temporarily stops normal breathing, a home monitor allows for continuous monitoring of your babys breathing and heart. Apnea of prematurity is defined as respiratory pauses 20 seconds or pauses disorders causing apnea. Cause may be central nervous system immaturity central apnea. Neonatology clinical treatment guidelines 1 ministry of health p. Pathologic apnea is a prolonged respiratory pause of. The result is a complete, integrated ventilation solution for the tiniest of patients.