Another common respiratory problem of premature babies is called apnea of prematurity. This occurs when the baby stops breathing. It often causes the heart rate and oxygen level in the blood to drop. Apnea occurs in almost of babies who are born before 28 weeks gestation. Itвs much less common in older premature babies, especially those born at 34 weeks or later. Apnea usually does not happen immediately after birth. It occurs more commonly at 1 to 2 days of age and sometimes is not obvious until after a baby has been weaned from a ventilator. There are two main causes of apnea in premature infants. The baby forgets to breathe, simply because the nervous system is immature. This is called central apnea. The baby tries to breathe, but the airway collapses. Air canвt flow in and out of the lungs. This is called obstructive apnea. Premature babies frequently have mixed apnea, which is a combination of central and obstructive apnea. A baby who is at risk for apnea needs to be connected to a monitor that records the heart rate, the breathing rate, and the oxygen level in the blood. If any of these rates fall below normal levels, an alarm sounds, alerting the hospital staff that the baby is having an episode of apnea.
The staff then stimulates the baby, usually by gently rubbing the baby s chest or back. The baby begins to breathe again. Occasionally, a baby requires assistance with a bag and mask to begin breathing again. Central apnea can be treated with a medication called, or with caffeine. Both of these drugs stimulate the baby s immature respiratory system and reduce the number of episodes of apnea. If they don t, or if the episodes are severe enough to require the staff to frequently stimulate the baby s breathing with a bag and mask, the baby may need to be put on a ventilator. This will be the case until the nervous system matures. Babies with purely obstructive apnea often need to be connected to a ventilator through an endotracheal tube to keep the airways open. Apnea of prematurity usually resolves by the time a baby is 40 to 44 weeks of age. This includes the number of weeks of pregnancy plus the number of weeks since the baby s birth. Sometimes, itвs resolved as early as 34 to 35 weeks. But occasionally, apnea persists and the baby requires long-term therapy. Parents may need to give their baby aminophylline or caffeine, and use an apnea monitor at home. In that case, parents are trained to use the monitor and to give CPR to stimulate breathing.
Babies are not sent home on a monitor unless they are otherwise stable and are having only rare episodes of apnea in a 24-hour period.
The earlier in the pregnancy a baby is born, the more likely that these breathing problems will occur. Many women who are likely to deliver prematurely have received steroid injections to try to help the babyБs lungs to work better after birth. Treatment after birth consists of two major forms of support. One is called CPAP (continuous positive airway pressure). This device consists of a mask or set of prongs extending a short distance into the nose, attached to an air source. A CPAP provides constant air pressure that is transmitted down into the babyБs lungs, helping them to become inflated and to stay inflated. This makes it easier for the baby to breathe independently. The length of time that a baby can require CPAP is extremely variable. It could be just a few hours or as long as several months. If a baby requires more help than the CPAP, this would mean putting the baby onto a ventilator or breathing machine. In order to do this, a tube has to be inserted through the babyБs mouth down into the babyБs windpipe.
The ventilator then works as a teammate with your babyБs lungs to improve the babyБs breathing status. Extra amounts of oxygen are often given through either the CPAP device or the ventilator. How long an individual baby will stay on a ventilator is extremely variable. It can be as short as a few hours or as long as several weeks. It is quite common for babies who have been on a ventilator to move to a CPAP as the next step toward recovery. An additional breathing problem that premature babies have is called apnea. Apnea means the baby has stopped breathing completely. It occurs because the part of the brain that controls breathing is not fully developed in a preterm baby. Although this problem is extremely common, it is usually easily controlled. Like most of the problems of prematurity, the baby will outgrow this problem just by getting older. Treatments for apnea include the use of CPAP as well as caffeine. (Yes, itБs the same drug that is in coffee and cola drinks. ) Caffeine stimulates the part of the brain that controls breathing to make the baby breathe more regularly. Caffeine therapy is safe and has been used for over 30 years in neonatal units.