Health Library

Apnoea of prematurity is a common condition in which babies who are born early (prematurely) stop or have a pause in breathing. There are 3 types of apnoea of prematurity:

1. Obstructive apnoea of prematurity. This type is caused by a blocked or collapsed airway.
2. Central apnoea of prematurity. This type happens when the part of the brain that controls breathing does not send the correct signals to the muscles that control breathing.
3. Mixed apnoea of prematurity. This is a combination of central apnoea and obstructive apnoea.

The condition gets better as the baby grows. After it goes away, the condition does not come back. This condition alone does not cause future health problems or developmental delays.

What are the causes?

This condition may be caused by:

Lack of development in the part of the brain that controls breathing.

Blockage or collapse of the airway, which may result from:

1. Weak muscles around the airway.
2. The neck bending forward or turning to the side.

What are the signs or symptoms?

The frequency and severity of apnoea episodes vary. The more premature a baby is, the more frequent and severe the symptoms are. Apnoea episodes may happen starting 2–3 days after birth and may last for up to 3 months after birth. During an episode:

1. Breathing stops or pauses for 20 seconds or longer. It may not start again without help.
2. The heart rate slows.
3. The blood oxygen level lowers, which may cause the baby's skin to turn pale or blue.
4. The baby may become limp.

The following may trigger or worsen apnoea episodes:

1. Infection.
2. Low red blood cells (anaemia).
3. Imbalance of electrolytes. These are salts and minerals in the blood.
4. Low oxygen level.
5. Low body temperature (hypothermia).

How is this diagnosed?

This condition is diagnosed by:

1. Monitoring episodes of apnoea and your baby's symptoms. This may include monitoring your baby's heart rate, breathing rate, and oxygen level.
2. Testing to rule out other possible causes of the apnoea, such as anaemia or infection.

How is this treated?

Treatment depends on the cause, frequency, and severity of symptoms. It may include:

Using a monitor to observe your baby's breathing. If the monitor finds a problem with breathing or heart rate, an alarm will go off. A healthcare provider will check your baby and do one or more of the following:

1. Watch your baby to see if they start breathing again.
2. Check and adjust your baby's airway and position, if needed.
3. Give your baby physical stimulation, such as gently rubbing the chest or back.
4. Give your baby a few breaths of oxygen from a bag and mask.

Medicines given by IV tube or by mouth to stimulate the part of the brain that controls breathing.

Breathing support. This can be done using:

1. A device that delivers air pressure through the nose. This may be a nasal continuous positive airway pressure (CPAP) or a nasal cannula.
2. A machine to help your baby breathe. This involves placing a tube in your baby's windpipe (trachea) or nose.

If your baby has problems that trigger or worsen apnoea, those problems will also be treated. Depending on your baby's condition, they may need:

1. A warmer (incubator) to help maintain body temperature.
2. Antibiotics to treat an infection.
3. Donated blood through an IV tube to treat anaemia.
4. Fluids by IV tube or mouth to establish a normal balance of electrolytes in the body.

Most babies will outgrow apnoea of prematurity as they get older and closer to going home from the hospital. It is important to spend time with your baby, including regular skin-to-skin or chest-to-chest contact (kangaroo care). If your baby is not medically stable enough to hold, ask the healthcare team how you can touch and bond with your baby. Some babies may need home apnoea monitoring. Your healthcare provider will let you know if this is right for your baby.

Follow these instructions at home:

Prematurity increases the risk for sudden infant death syndrome (SIDS). Safe sleeping positions are important for lowering the risk of SIDS for your baby. Some premature babies may be positioned on their stomachs while in the hospital and on monitoring. Before going home, your baby will become adapted to only sleeping on their back. Follow these instructions for safe sleep habits:

Always place your baby on their back for bedtime and for a nap. Do this until your baby is 1 year old.

Placing your baby lying on their stomach (tummy time) should only be done when your baby is awake.

If you have questions, ask your healthcare provider about safe sleep positioning for your baby.

Medicines

Give your baby over-the-counter and prescription medicines only as instructed by their healthcare provider.

Get help right away if:

1. Your baby turns pale or blue and is not breathing.
2. Your child who is younger than 3 months has a temperature of 38°C (100.4°F) or higher.

These symptoms may be an emergency. Do not wait to see if the symptoms will go away. Get help right away. Call your local emergency services.

Summary

1. Apnoea of prematurity is a condition in which babies who are born early (prematurely) stop or have a pause in breathing.
2. During an apnoea episode, breathing stops or pauses for 20 seconds or longer. The baby's heart rate slows, and the baby may turn pale or blue.
3. This condition may be caused by a lack of development in the part of the brain stem that controls breathing. It may also be caused by a blocked or collapsed airway.
4. Most babies will outgrow apnoea of prematurity as they get older and closer to going home from the hospital.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.