Infant Apnea. All You Need to Know.

What is apnea of ​​the infant?

Apnea is a temporary interruption of breathing . Among children, this is more common in newborns.

Why is it produced?

Babies born prematurely (before 34 weeks gestation) generally have an underdeveloped central nervous system . One of the consequences of this immaturity is inadequate control of your respiratory reflex. The more premature a baby is, the greater the chance of apnea.

Apnea episodes are more of a problem for smaller babies than for larger babies. A small baby stores a smaller amount of oxygen, so the effects of oxygen deprivation are more severe.

Apnea usually appears within the first few days after the baby is born.

How many types of infant apneas are there?

We could say that infant apnea is a physical manifestation of an underdeveloped nervous system. Apnea is a symptom that has a great possibility of etiologies. This article describes some of the main ones that can affect a baby.

The three main categories of apnea are:

  • Central apnea: Central apnea is the result of an inadequate spinal response and, therefore, poor or no muscular coordination for breathing.
    Obstructive apnea : Obstructive apnea is when there is an obstruction of the airways and, therefore, little or no air exchange. Many times with obstructive apnea, there is a vigorous inspiratory effort, but it is ineffective.
    Mixed apnea: Mixed apnea refers to an episode in which central and obstructive forces are combined.

The most common presentations of infant apnea are described below.

Sleep apnea in babies

The apnea sleep in infants is a respiratory disorder related to sleep. This set of related conditions includes mixed sleep apnea , which is more common in premature babies, and central sleep apnea , which develops more often in full-term babies. Parents should be aware that small interruptions in breathing are common in babies under 6 months of age and are not considered dangerous. Apnea usually occurs during sleep and is primarily a disorder that occurs in premature babies. Before 2000 it was thought that sleep apnea It was a disease of the elderly, but it can also occur in children, unfortunately.

If your baby suffers an episode of mild apnea , it will not have greater consequences than the fright that you will get. In these cases, the pause for breathing is short ( 10-15 seconds ) and the baby begins to breathe on its own again. Breathing interruptions of up to 15 seconds can be normal. Known as periodic breathing, this is not a symptom of sleep apnea and is generally not dangerous . It is very common in premature babies.

However, in a severe apnea episode , breathing may stop for 20 seconds or more .

The following symptoms are related to more severe breathing difficulties that may indicate sleep apnea.

RESPIRATORY CESSATION GREATER THAN 20 SECONDS

A cessation of breathing during sleep in babies of 20 seconds or more is the definition of infant or infant apnea .

Visit the pediatrician and inform him that your baby has longer pauses in breathing, especially if the following symptoms are also present.

If your baby does not respond to a slight push during these prolonged respiratory interruptions, call your community health emergencies.

CYANOSIS … TURNING BLUE

If your baby begins to turn blue ( cyanosis ) due to lack of oxygen in the blood, it will retain carbon dioxide and may become unconscious unless you stimulate it to breathe again.

A blue forehead and torso are warning signs of oxygen depletion. Babies with a forehead and / or trunk that turn blue show clear signs of oxygen deficiency caused by breathing difficulties. Bluish lips are normal at times, so keep an eye out, too, for an unpleasant-looking general facial appearance, such as haggard appearance.

GASPING AND GAGGING

The gasping and gagging for breath after a long cessation of breathing is a worrying symptom of sleep apnea. In central sleep apnea, the brain essentially “forgets” to send the breathing signal to the baby’s diaphragm. In premature babies, central sleep apnea is often the cause followed by an obstruction in breathing due to immaturity of the respiratory system.

CLEAN

An additional symptom of sleep apnea in babies is a limp of the muscles. This is due to low oxygen levels in the extremities, as available oxygen is mainly reserved for the functions of the central organs.

SLOW HEARTBEAT

A slow heart rate is cause enough for a baby checkup. Babies with sleep apnea may have a slower heartbeat than normal. This complication, known as bradycardia , can be dangerous as it can lead to sudden unconsciousness in which the baby needs resuscitation. Although this symptom is highly concerning and is linked by some to Sudden Infant Death Syndrome , there is no clear evidence that correlates sleep apnea with Sudden Infant Death Syndrome today.

In any case, you should contact your pediatrician immediately to arrange a sleep apnea test if your baby has a reduced heart rate.

Late apnea

Premature babies are at higher risk for what is known as late apnea. This occurs when the baby is over six weeks old . Delayed apnea can also affect full-term babies and can be a sign of an underlying problem such as congenital heart disease , infection , anemia , meningitis, or seizures .

The baby recovers from apnea as the underlying disease is treated in most cases. Even if no underlying cause is found, late apnea is overcome by the baby’s one year old.

Pain from gastroesophageal reflux

The reflux is defined as the backward step involuntary of gastric contents into the esophagus with or without regurgitation or vomiting. It is a frequently experienced physiological condition that occurs several times a day, usually after food intake, and does not cause any symptoms.

Gastroesophageal reflux disease (GERD) occurs when the reflux of gastric contents causes symptoms that affect the quality of life or pathological complications, such as lack of development, feeding or sleep problems, chronic respiratory disorders, esophagitis, hematemesis, apnea and other life-threatening events. About 70-85% of infants have regurgitation in the first two months of life, and this resolves without intervention in 95% of infants in the first year of age.

The predominant mechanism that causes GERD is transient relaxation of the lower esophageal sphincter. Spitting up and vomiting are the most common symptoms of childhood reflux . A complete medical history and physical examination with attention to warning signs suggesting other causes is generally sufficient to establish a clinical diagnosis of mild childhood GERD.

The suffocation , the nausea , the coughing food or significant irritability may be warning signs for GERD or other diagnoses. If there is severe vomiting, laboratory and radiographic tests (upper gastrointestinal series) are warranted to exclude other causes of vomiting.

Irritability , along with arching of the back in infants, is believed to be a non-verbal equivalent of heartburn in older children. Other causes of irritability, such as allergy to cow’s milk proteins, neurological disorders, constipation, and infection, must be ruled out prior to a GERD diagnosis.

Gastroesophageal reflux apnea is one of the extraesophageal manifestations of GERD in infants.

GERD CAN CAUSE APNEA FOR TWO REASONS:

If an episode of airway obstruction occurs in the hour following the baby’s food intake, we must think of GERD as the cause of it. Laryngospasm usually occurs in newborns, either during sleep or wakefulness. The physical manifestation of laryngospasm is very silent, so parents are terrified of not realizing when it occurs. The baby keeps his gaze fixed, as if lost; her body has a very tense posture and her face is turning bluish. There is no movement or sound to make us suspicious or alert. No cough, no choking, no vomiting …

  • central reflex mechanism.

Unlike the previous one, in the case of the central reflex mechanism the baby is eating, so when awake the warning signs are easier to identify. It is accompanied by a decrease in heart rate (bradycardia).

If you want to know more about gastroesophageal reflux, I invite you to read this: Baby Reflux. Early Detection, Natural Remedies, Causes and Diagnosis

What should you do in an episode of apnea?

Sometimes rubbing the baby with a finger or tapping the soles of the feet may be all that is needed to end a short episode of apnea. However, if the baby has become unconscious, he may need an oxygen mask to recover.

If the apnea is frequent or severe, the pediatrician may decide to treat it by altering conditions in the incubator , such as lowering the temperature, increasing the oxygen, or placing the baby in a rocking incubator. Blood transfusions and medications may also be necessary.

Can infant apnea be prevented?

As we have said before, in newborn apnea, breathing stops and starts again automatically after a few seconds. It can also cause a prolonged pause that requires the baby to be resuscitated. Babies born before 34 weeks gestation do not have a fully developed central nervous system, and they often do not have adequate control of the respiratory reflex.

More information about the Respiratory Reflex.

For the above reasons, I am sorry to tell you that there are no specific measures to prevent infant apnea . As it is a sign of immaturity in development, we can reassure ourselves knowing that it will decrease as the baby grows .

Typically, a premature baby will be continuously monitored in an incubator and apnea can be easily detected by hospital staff. In the event of a drop in the baby’s heart or respiratory rate, an alarm will sound and the nurse will proceed to stimulate the baby to resume breathing, if necessary.

In cases of late apnea, parents may not notice that the baby stops breathing while sleeping. When you suspect or have diagnosed your baby apnea, you should consider installing a monitor at home until the problem, doubt or problem is resolved. This is especially important during the first weeks of life or until the baby reaches an age commensurate with full-term gestation. Sadly, this measure is very expensive if not prescribed by a public health pediatrician.

Here you can find  some basic monitors .

How should parents act?

If apnea is diagnosed, it will likely reappear, which is why it terrifies parents the most.

Most premature babies overcome apnea by the time they reach their normal due date, as their nervous system will be fully mature and developed by that date.

However, undiagnosed late apnea can be fatal and is associated with sudden infant death syndrome (SIDS) .

In my opinion, all parents of premature babies should be informed of the possibility of apnea. You must monitor the breathing patterns of the baby who is born prematurely. You should also be trained and given instructions to be able to resuscitate your baby if a serious episode occurs (yes, I am referring to CPR: cardiopulmonary resuscitation ). This measure would help a lot to reduce the risk that your baby is seriously damaged by the effects caused by the lack of oxygen … effects that can be irreversible and irreparable. In addition, it would greatly help you to be more relaxed, having the peace of mind that you will know how to act correctly in case of need.

If your health centers or your medical professionals do not provide you with this training, I recommend to all those who are particularly concerned about late apnea, that you look for a way to be trained and informed about first aid for children.

Because apnea usually occurs during sleep, parents may choose to sleep close to the baby. In very serious cases, if the baby is not monitored, some parents choose to sleep in shifts.

When should I call the doctor?

My recommendation is that all parents of a newborn who have already settled at home with their baby, visit the pediatrician from the first moment they notice that the baby has episodes of interruption of breathing during sleep. This is vital if the baby was born prematurely or has other medical conditions that raise the alarm.

How is infant apnea diagnosed?

The diagnosis of sleep apnea in newborns is made by observing the baby by a doctor, and medical tests may be necessary for an accurate diagnosis. Premature babies still in the hospital under neonatal care are monitored by machines that alert staff when a baby stops breathing.

To diagnose the apnea induced by gastroesophageal reflux , either by laryngospasm or central reflex mechanism, the pediatrician will have to resort to another series of tests such as the determination of the esophageal pH or the sleep study .

Is there treatment?

Sleep apnea in babies is treated by gently stimulating children by stroking their bodies. Touching them in this way induces them to resume breathing. In severe cases, it may be necessary to give oxygen or medicine to the baby.

In the case of apnea due to gastroesophageal reflux, the treatment will be that corresponding to the cure of GERD, additionally taking preventive measures that allow us to control the baby in case of presenting an apneic episode.

Apneas also occur in adults. If you want to go deeper, just go here: Idiopathic Sleep Apnea: Symptoms, Causes and Treatments

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Kathie Sand always saw the world of beauty as the terrain on which to build her professional career, a goal that was clear to her when she was only 15 years old. Her great concern to expand knowledge led her to settle in Paris where she studied hand in hand with the best beauty professionals and with the most advanced techniques for skin care.

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