AOP

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AOP

Alternative Names

Apnea - newborns; AOP; As and Bs; Blue spell - newborns; Dusky spell - newborns; Spell - newborns

Definition

Newborns, especially premies, often have a breathing pattern that is immature and irregular. These babies often stop breathing for short periods, which is called apnea.

Breathing is also sometimes described as "periodic," with times of normal breathing that progress to very shallow breathing. When there is very shallow or no breathing (apnea), the baby may also experience a drop in the heart rate. This heart rate drop is called bradycardia.

Causes

In newborns, especially those born prematurely, several things contribute to apnea -- including immaturity of the brain and weakness of the muscles that keep the airway open. At times, additional stresses in a sick or premature baby may worsen apnea. These include infection, heart or lung problems, low blood count (anemia), low oxygen levels, temperature problems, feeding problems, and over stimulation.

Symptoms

Babies with apnea or bradycardia can set off monitor alarms. Or, the babies may simply be observed to have episodes where they stop breathing. The baby may or may not have associated poor color and an appearance of not looking well.

Exams and Tests

Because most preterm and some ill term babies have some degree of apnea, they are usually kept on monitors that measure heart rate and breathing rate. Alarms are set to notify the staff when lower heart rate or breathing rate limits are met.

Treatment

Treatment of apnea depends on the situation, including the most likely causes, the frequency of spells, and the severity of spells. Babies who appear to be otherwise healthy with few spells per day are simply watched and can be gently stimulated during their occasional episodes.

Babies who are well appearing with multiple spells may be placed on a caffeine preparation to help stimulate their breathing.

Proper positioning, slower feeding time, oxygen, and (in extreme cases) ventilator support may be needed to assist in breathing. Babies who have worsening apnea or appear ill are often studied and treated for the causes.

Outlook (Prognosis)

Because apnea is common in the premature population, and because most of these babies have normal outcomes, it is felt that mild apnea does not have long-term effects. However, most doctors feel that prevention of multiple or severe episodes is better for the baby on the long term.

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