Seminar Presentation2 On Apnea

COLLEGE OF HEALTH SCIENCES SCHOOL OF
NURSING AND MIDWIFERY POSTGRADUATE

PROGRAM
SEMINAR PRESENTATION:-NEONATAL APNEA
by Deribew.A
05/12/2024
Course outline
Objective
Definition
Types of neonatal apnea
Etiology of neonatal apnea
Diagnosis of neonatal apnea
Management of neonatal apnea
Prevention of neonatal apnea

05/12/2024
Objectives
At the end of the session the learner will able to:-
Define neonatal apnea
Discuss on the Types of neonatal apnea
List the Etiology of neonatal apnea
Discuss on the Diagnosis of neonatal apnea
Discuss on Management of neonatal apnea
Identify Prevention method of neonatal apnea

05/12/2024
Neonatal Apnea
o Apnea is defined as cessation of breathing for

longer than 20 sec, or for shorter duration in
presence of bradycardia(<100bpm), cyanosis and
hypoxemia(SPO2 <85%).
o Usually apnea for 20 seconds or longer is needed to

produce these clinical signs.
05/12/2024
Types of neonatal apnea
1. Central – total cessation of respiratory effort with

no evidence of obstruction (no respiratory efforts,
no airflow)
2. Obstructive – no airflow, despite respiratory

efforts
3. Mixed – often begins as central and later becomes

obstructive. The most common.
05/12/2024
Etiology
 Apnea is commonly occurs in premature new borns

related to immaturity of the respiratory control
system.
 generally begins 1 or 2 days after birth and called

apnea of prematurity (AOP).
 In term new borns, it occurs in association with

serious identifiable causes.
05/12/2024
Cont…
 Apnea occurring in first 24 hours and beyond 7
days of life is more likely to have a secondary cause
than being AoP.
Secondary causes of apnea include:-
1. Temperature instability: hypothermia and

hyperthermia, especially frequent fluctuations in
body temperature
05/12/2024
Cont….
2. Metabolic: acidosis, hypoglycemia, hypocalcaemia,
hyponatremia, hypernatremia
3. Hematological: anemia, polycythemia
4. Neurological: intracranial infections, intracranial

hemorrhage, seizures, perinatal asphyxia, and placental
transfer of drugs such as narcotics, magnesium
sulphate, or general anesthetics
05/12/2024
Cont…
5. Pulmonary: respiratory distress syndrome (RDS),

pneumonia, pulmonary hemorrhage, obstructive airway
lesion, pneumothorax, hypoxemia, hypercarbia, airway
obstruction due to neck flexion.
6. Cardiac: congenital heart disease, hypo/hypertension,

congestive heart failure, patent ductus arteriosus
05/12/2024
Cont..
7.Gastro-intestinal: gastro esophageal reflux,

aspiration, abdominal distension, NEC
8. Infections: sepsis, pneumonia, meningitis.
AOP is a diagnosis of exclusion.
05/12/2024
PATHOGENESIS
Apnea of prematurity is a developmental disorder

that reflects physiologic rather than pathologic
immaturity of respiratory control.
the exact mechanisms responsible for apnea in

premature infants have not been clearly identified.
05/12/2024
Factors Implicated in the Pathogenesis of Apnea of Prematurity
1. Central Mechanisms 2.Peripheral Reflex Pathways
Decreased central Decreased carotid body

activity
chemosensitivity Increased carotid body
activity
Hypoxic ventilatory
Laryngeal chemoreflex
depression Excessive bradycardic
response to hypoxia
Upregulated inhibitory
3. Others
neurotransmitters, e.g., Genetic predisposition
GABA, adenosine
05/12/2024
05/12/2024
Diagnosis
The diagnosis of apnea is usually made by

observing the breathing pattern, color and heart rate
of new born.
An oxygen saturation monitor will indicate a fall in

oxygen saturation when the infant has apnea.
05/12/2024
Management of AOP
General measures
Resuscitate patient first:-
Stimulate the baby by rubbing his chest or feet for

10 seconds
Suction mouth and nose
If the baby does not begin to breathe immediately,

position head in a neutral position and ventilate
using a bag and mask.
05/12/2024
Cont…
If oxygen saturations <90%, start oxygen
Check glucose level with glucometer and correct as

indicated
Maintain environmental temperature
Immediate investigations are blood sugar, PCV,

sepsis screening, electrolytes and cranial ultrasound
scan to rule out IVH.
05/12/2024
Cont…
Start CPAP with close monitoring especially if
recurrent apnea.
Treat the underlying cause: sepsis, anemia,

polycythemia, hypoglycemia, hypocalcemia,
respiratory distress syndrome (RDS).
KMC should be continued or started if baby is

stable.
05/12/2024
Cont..
 Aminophylline – loading dose 8mg/kg Iv infusion over

30 minutes
 Maintenance – 1.5 to 3mg/kg IV every 8 to 12 hours.
 Caffeine – loading dose 20 to 25mg/kg of caffeine
citrate IV over 30 min or orally.
 Maintenance --- 5 to 10 mg/kg per dose of caffeine
citrate IV slowly push or orally every 24hr.
05/12/2024
Prevention
About 25% of neonates <34 weeks have apnea of
prematurity.
Therefore, it is reasonable to start

caffeine/aminophylline prophylactically to all
premature infants of gestational age <32 weeks or
weight <1250g.
If caffeine is available this would be the first choice

over aminophylline.
05/12/2024
Cont…
Very low birthweight (<1500g) babies should
receive prophylactic caffeine/ aminophylline orally
until they reach 1.5kg or 34 weeks GA, whichever
comes first.
Maintain normal hematocrit, electrolytes and PaO 2
Avoid neck flexion and abdominal distension
KMC
05/12/2024
Dosages of caffeine citrate and aminophylline
Caffeine Dose:-
Loading dose: 20mg/kg caffeine citrate IV mainly or

NG/PO (depending on the circumstances) stat on
from birth on Day 1
Then maintenance: 5-10mg/kg/day caffeine citrate IV

or NG/PO given as once daily dose in the morning.
05/12/2024
Aminophylline dose (if caffeine citrate is not
available)
Loading dose: 5mg/kg aminophylline IV (or PO)

given slowly over 20min
Then maintenance: 2mg/kg /per dose twice daily

(IV or per oral PO) starting 24hours after loading
05/12/2024
05/12/2024
Reference
Neonatal Intensive Care Unit Training Participant`s manual
Ministry of Health, Ethiopia January, 2024.
Eichenwald EC and AAP COMMITTEE ON FETUS AND

NEWBORN, Apnea of Prematurity, Pediatrics, 2016.
WHO neonatal-clinical-guidelines-2018-2021
Fanaroff and Martins Neonatal Perinatal Medicne 10th

edition.
neoFax drug monography summary 2020
05/12/2024
OU
KY
AN
TH
05/12/2024

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COLLEGE OF HEALTH SCIENCES SCHOOL OF

NURSING AND MIDWIFERY POSTGRADUATE

SEMINAR PRESENTATION:-NEONATAL APNEA

Types of neonatal apnea

Etiology of neonatal apnea

Diagnosis of neonatal apnea

Management of neonatal apnea

Prevention of neonatal apnea

Define neonatal apnea

Discuss on the Types of neonatal apnea

List the Etiology of neonatal apnea

Discuss on the Diagnosis of neonatal apnea

Discuss on Management of neonatal apnea

Identify Prevention method of neonatal apnea

o Apnea is defined as cessation of breathing for

o Usually apnea for 20 seconds or longer is needed to

1. Central – total cessation of respiratory effort with

2. Obstructive – no airflow, despite respiratory

3. Mixed – often begins as central and later becomes

 Apnea is commonly occurs in premature new borns

 generally begins 1 or 2 days after birth and called

 In term new borns, it occurs in association with

Secondary causes of apnea include:-

1. Temperature instability: hypothermia and

3. Hematological: anemia, polycythemia

4. Neurological: intracranial infections, intracranial

5. Pulmonary: respiratory distress syndrome (RDS),

6. Cardiac: congenital heart disease, hypo/hypertension,

7.Gastro-intestinal: gastro esophageal reflux,

8. Infections: sepsis, pneumonia, meningitis.

AOP is a diagnosis of exclusion.

Apnea of prematurity is a developmental disorder

the exact mechanisms responsible for apnea in

1. Central Mechanisms 2.Peripheral Reflex Pathways

Decreased central Decreased carotid body

The diagnosis of apnea is usually made by

An oxygen saturation monitor will indicate a fall in

Stimulate the baby by rubbing his chest or feet for

Suction mouth and nose

If the baby does not begin to breathe immediately,

If oxygen saturations <90%, start oxygen

Check glucose level with glucometer and correct as

Maintain environmental temperature

Immediate investigations are blood sugar, PCV,

Treat the underlying cause: sepsis, anemia,

KMC should be continued or started if baby is

 Aminophylline – loading dose 8mg/kg Iv infusion over

Therefore, it is reasonable to start

If caffeine is available this would be the first choice

Maintain normal hematocrit, electrolytes and PaO 2

Avoid neck flexion and abdominal distension

Loading dose: 20mg/kg caffeine citrate IV mainly or

Then maintenance: 5-10mg/kg/day caffeine citrate IV

Loading dose: 5mg/kg aminophylline IV (or PO)

Then maintenance: 2mg/kg /per dose twice daily

Eichenwald EC and AAP COMMITTEE ON FETUS AND

Fanaroff and Martins Neonatal Perinatal Medicne 10th

neoFax drug monography summary 2020

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