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Apnea of Prematurity (1) 2

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22 views10 pages

Apnea of Prematurity (1) 2

Uploaded by

dursaoro
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Apnea of Prematurity

(AOP)
By Dr NEJAT NEJIB (MD )
Apnea of Prematurity
• Apnea is defined as cessation of breathing for a
period of ≥20 sec,
or
a period <20 sec that is associated with a change
in tone, pallor, cyanosis, or bradycardia
(<80-100 beats/min)
• Based on the absence of respiratory effort
and/or airflow, apnea can be
• Obstructive
• central,
• mixed
2
Apnea of Prematurity con`d
• Central apnea
• Inspiratory efforts are absent
• Caused by decreased CNS stimuli to respiratory muscle
• No airflow and chest wall motion
• Obstructive apnea
• Inspiratory efforts persist, but are ineffective in the
presence of upper airway obstruction
• characterized by absence of airflow but persistent
chest wall motion.
• Mixed apnea
• Upper airway obstruction with inspiratory efforts that
precedes or follows central apnea
• Usually obstructive apnea preceding central apnea
3
Apnea of Prematurity con`d
• INCIDENCE
• varies inversely with GA
• Is almost universal in infants born at <28 wk GA
• 85% in infants <30 to 28 wk GA to
• 20% in infants <34 to 30 wk GA
Apnea of Prematurity con`d
• Results from immature respiratory control or an
associated illness
• Most frequently occurs in infants <34 wk of (GA)
• Occurs in the absence of identifiable predisposing
diseases.
• Its frequency increases during active (REM) sleep
• The incidence of apnea increases with decreasing GA
• The onset can be during the initial days to weeks of age
• Often delayed if there is RDS or other causes of
respiratory distress

5
Apnea of Prematurity con`d

• DIAGNOSIS
• The diagnosis is a diagnosis of exclusion
• Other causes of apnea need to be considered and eliminated
• Apnea that occurs in the absence of other clinical signs of
illness in the 1st 2 wk in a preterm infant is likely apnea of
prematurity
• The onset of apnea after the 2nd wk of life may be
associated with serious underlying pathology
Apnea of Prematurity con`d
DIFFERENTIAL DIAGNOSIS
• Hypoxemia
• Anemia
• Infection, including sepsis
• Metabolic disorders
• Unstable thermal environment (especially warming)
• Antepartum administration of magnesium sulfate or opiates to the mother
• Administration of opiates or general anesthesia to the infant
• Neurologic disorders, including intracranial hemorrhage and neonatal
encephalopathy [28]
• Necrotizing enterocolitis (NEC)
• Congenital anomalies of the upper airway
• Seizure
Apnea of Prematurity con`d
Treatment
• GENERAL MEASURES ( non-pharmacological)
• Gentle tactile stimulation
• Environmental temperature control
• Head and neck position – avoid extreme flexion or extension of the neck
• Maintain nasal patency – avoiding vigorous nasal suctioning or
prolonged use of NGT
• Oxygen to maintain SpO2 at 90 to 95%
• nCPAP (3-5 cm H2 O)
• Mechanical ventilation
Apnea of Prematurity con`d
• PHARMACOLOGICAL
• Methylxanthines (Caffeine and Aminophylline)
• Are effective for Rx of recurrent or persistent apnea of AOP
• Respiratory center stimulation by inhibiting adenosine
receptors
• Increased diaphragmatic contraction and preventing
diaphragmatic fatigue
• CAFFEINE
• loading dose 20 mg/kg
• 2.5 - 5 mg /kg / day once per day
• AMINOPHYLLINE
• loading dose 8 mg/kg
• 1.5-3 mg/kg/dose 3 times a day
Thank you!!

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