MONITORING :

All preterm infants should be closely monitored for the development of this often life-threatening condition. Close attention should be paid to the type of monitoring that is given to infants in intensive care units. Preterm infants are commonly on heart rate monitors only, and they will be identified as having apnea only if the heart rate drops below the monitor alarm limit (usually set at 80 beats/min). In this case, these infants may suffer profound hypoxia before bradycardia develops, or they may have apnea with significant hypoxemia but without a drop in heart rate. In order to detect apnea, these infants should have continuous monitoring of respiratory activity or monitoring of oxygenation, or both, using either transcutaneous oximetry or pulse oximetry. (1)

PRINCIPLES OF THERAPY :

Therapy for Apnea can be divided arbitrarily into four groupings based on proposed pathogenic mechanisms that might result in apnea. Institution of interventions should occur in the order of increasing invasiveness and risk. Debate regarding risk of interventions persists, some authors advocating use of methylxanthines prior to CPAP therapy.

Increase Afferent Input into the Respiratory Centers :

• Cutaneous or vestibular stimulation
• Avoid hyperoxia

Treatment of Primary Depression of Respiratory Center :

• Treat infection
• Correct metabolic disturbances
• Administer central nervous system stimulants (aminophylline, theophylline, caffeine, doxapram)

Treatment of Hypoxemia :

• Treat HMD, pneumonia, aspiration, etc.
• Increase inspired oxygen
• Apply continuous positive airway pressure (CPAP)
• Prone positioning
• Treat congestive heart failure
• Close patent ducts arteries
• Transfuse with packed red blood cells

Avoidance of Triggering Reflexes :

• Beware of suction catheters
• Avoid nipple feedings (feed by tube or intravenously)
• Avoid hyperinflation and hyperventilation during bagging
• Avoid cold stimuli to the face
• Place infant in the prone position
• Avoid severe flexion of neck
• Treat gastro esophageal reflux