Apnoea in neonates is defined as periods where breathing stops spontaneously for more than 20 seconds or shorter periods associated with oxygen desaturation (SpO2 <90%) or bradycardia (heart rate <100). They can occur in neonates of all gestational ages. They are often accompanied by a period of bradycardia (slow heart rate).
Apnoea is very common in premature neonates. The incidence decreases with increased gestational age. They occur in almost all neonates born at less than 28 weeks gestation. In term infants, they usually indicate underlying pathology.
Causes
Apnoea occurs due to immaturity of the autonomic nervous system that controls respiration and heart rate.
Apnoea may indicate an underlying illness, such as:
- Infection
- Anaemia
- Airway obstruction (may be positional)
- Central nervous system pathology (e.g., intraventricular haemorrhage or seizures)
- Gastro-oesophageal reflux
- Neonatal abstinence syndrome (due to maternal substance use)
- Hypoglycaemia
Management
Neonatal units use apnoea monitors, which make a sound when an apnoea occurs.
Tactile stimulation is used to prompt the baby to restart breathing.
Intravenous caffeine citrate can be used to prevent apnoea and bradycardia in babies with recurrent episodes.
Apnoea episodes resolve as the baby grows and develops, usually by 36-40 weeks corrected gestational age.
Last updated May 2025
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