Pediatric Apnea: Causes, Care, and Treatment Options

Respiratory arrest

Hello, doctor: My baby was born at 37 weeks, and both had a birth weight under 2000 grams.
One was born on October 9 weighing 1830 grams, and the other 1750 grams, so they are in the incubator.
Their organs are all functioning well, but currently, their heart rates drop to around 40 beats per minute while sleeping, sometimes even into the 20s.
The other baby's heart rate drops to about 80 beats per minute, and their respiratory rates fall to the 20s.
Blood gas levels are normal, and they have undergone ECG, EEG, and blood tests, all of which are normal.
The doctor's interpretation suggests that the babies sometimes forget to breathe, and no other causes have been found.
What treatment should be administered in this case? Is complete recovery possible? What methods are available? Should they be referred to a cardiologist, or continue to see a pediatrician? Could you provide some professional advice? Additionally, the babies are too small to breastfeed and are being fed with a cup, consuming only 20-30 ml of milk.
Their cries are weak, resembling a cat's meow.
How can we care for them to improve their condition?

Mao, 20~29 year old female. Ask Date: 2009/10/13

Dr. Xiao Kaiwen reply Pediatrics

There are many causes of apnea, such as prematurity, neurological issues (like bleeding or simply immaturity), cardiac problems, airway soft tissue obstruction, gastroesophageal reflux, infections, anemia, and hypoglycemia, among others.
Each cause needs to be investigated gradually, starting with the more common ones.
Gradually increasing cup feeding is an appropriate approach for low birth weight newborns.
Newborns with lower weight tend to have weaker cries; if there are no pathological conditions (such as infections), their condition will naturally improve as they gain weight successfully.

Reply Date: 2009/10/13

More Info

Pediatric apnea, particularly in preterm infants, is a condition that can be concerning for parents and caregivers. It is characterized by pauses in breathing that can last for more than 20 seconds, often accompanied by bradycardia (a slow heart rate) and oxygen desaturation. In your case, it appears that your twins, born at 37 weeks and with low birth weights, are experiencing episodes of apnea, which is not uncommon in premature infants.

Causes of Pediatric Apnea
Apnea in infants can be caused by several factors, including:
1. Prematurity: Infants born prematurely often have underdeveloped respiratory systems, which can lead to irregular breathing patterns.

2. Neurological Factors: Conditions affecting the brain, such as intraventricular hemorrhage, can impact the respiratory centers.

3. Gastroesophageal Reflux: This can irritate the airway and lead to apnea.

4. Infections: Respiratory infections can also contribute to episodes of apnea.

5. Metabolic Issues: Low blood sugar or electrolyte imbalances can cause breathing irregularities.

Diagnosis and Monitoring
It’s reassuring that your infants have undergone several tests, including ECG, EEG, and blood tests, which have returned normal results. Continuous monitoring in a neonatal intensive care unit (NICU) is crucial for infants with apnea, as it allows for immediate intervention if necessary.

Treatment Options
1. Stimulation: Gentle tactile stimulation can often help to prompt breathing in infants experiencing apnea.

2. Caffeine Therapy: Caffeine citrate is commonly used in NICUs to stimulate the respiratory drive in preterm infants and reduce the frequency of apnea episodes.

3. Positioning: Keeping the infant in a slightly elevated position can help with breathing and reduce the risk of reflux.

4. Monitoring: Continuous pulse oximetry and cardiorespiratory monitoring can help track the infant's heart rate and oxygen levels, alerting caregivers to any concerning changes.

Prognosis
Many infants outgrow apnea as their respiratory systems mature, particularly those born closer to term. The prognosis is generally good, especially with appropriate monitoring and intervention. However, it is essential to maintain regular follow-ups with your pediatrician or a pediatric pulmonologist to monitor their progress and address any ongoing concerns.

Feeding and Care
Given that your infants are not yet able to breastfeed effectively, cup feeding is a suitable alternative. It’s important to ensure they are receiving adequate nutrition, even if the amounts are small. Here are some tips for care:
1. Frequent Feeding: Offer small amounts frequently to ensure they are getting enough nutrition without overwhelming them.

2. Calm Environment: Create a soothing environment during feeding to help them feel secure and reduce stress.

3. Monitor Weight Gain: Regularly check their weight gain to ensure they are growing appropriately.

4. Encourage Bonding: Skin-to-skin contact can be beneficial for both the infants and parents, promoting bonding and potentially improving feeding.

When to Seek Further Help
If you notice any changes in their breathing patterns, feeding difficulties, or if they seem unusually lethargic, it is crucial to seek medical attention promptly. Your pediatrician can provide guidance on whether a referral to a pediatric pulmonologist or a sleep specialist is necessary.

In conclusion, while apnea can be alarming, many infants, especially those born prematurely, experience it as part of their development. With appropriate care, monitoring, and intervention, most infants will outgrow these episodes as they mature. Regular communication with your healthcare team will be essential in navigating this challenging time.

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