Apnea and Bradycardia in Preemies

When a baby is born premature, her lungs and the part of her brain that controls breathing are not fully mature.  A preemie cannot control breathing like a full term baby can.  Instead of having a regular constant breathing pattern, preemies tend to take big breaths of air followed by shallow breathing or pauses in breathing.  A preemie may be diagnosed with apnea if she has pauses in breathing that last for more than 15 to 20 seconds.  When this happens her color may turn bluish or purple and her heart rate may slow down.  Bradycardia is the medical term for a slow heart rate.  When a baby has bradycardia her heart rate may drop to less than 80 beats per minute.

Treatment for preemies with apnea and bradycardia

It is fairly common for a premature baby to have issues with apnea or bradycardia.  Most premature babies spend some time in the NICU or Neonatal Intensive Care Unit.  While your baby is in the NICU, she may require a mechanical ventilator to help her breathe or a nasal CPAP (continuous positive airway pressure) device to assist her with breathing.  Once your preemie is breathing on her own, she will be monitored with a cardiorespiratory monitor (or apnea and bradycardia monitor).  If your baby stops breathing or her heart rate slows, the nurse will fist try to get her breathing by rubbing her back, arms or legs, or tapping on the soles of her feet. Most of the time, this is all it takes to stimulate breathing.  If your baby does not begin breathing on her own, the nurse may administer oxygen to get her breathing again. 

Apnea is common in preemies, but it often resolves on its own by the time your preemie is ready to be discharged.  However, some preemies continue to have episodes of apnea and require continued monitoring.  If your preemie continues to have issues with apnea, she may be sent home with an apnea monitor.  You will be required to have training on how to use the apnea monitor before your baby can be discharged.  You will also be given training on how to perform infant CPR if your baby is sent home on an apnea monitor.  Some babies will also be given a stimulant medication to help them breathe.

When your preemie is sent home on an apnea monitor

An apnea monitor is a portable device that your baby will wear to monitor her breathing and heart rate.  The monitor is a small unit with an alarm.   Your baby is connected to this unit with leads that are either attached to your baby with a belt or sticky pads.  You will be given instructions on how to attach the leads to your baby’s chest.  The monitor constantly checks your baby’s breathing and heart rate.  It will sound an alarm if your baby’s breathing pauses or heart rate slows. 

What to do when the apnea monitor alarm sounds

If the apnea monitor alarm sounds, you should look at your baby and see if she appears to be breathing.  Check her color and try to stimulate her by rubbing her back, arms or legs.  You can also tap the bottom of her feet.  If she does not appear to breathing and you have tried stimulating her by touch, you should call 911 immediately.

You may experience false alarms with the apnea monitor.  Sometimes the monitor will alarm and your baby is breathing fine.  This can happen if the leads become unattached or the battery is low.  Try to readjust the leads or change the leads when this happens.  If you are having a lot of issues with false alarms, contact your health care provider. 

How long will my preemie need to be on an apnea monitor?

Preemies often outgrow apnea and bradycardia by the time they reach their full term gestational age (or by the time they reach the date they would have been born, your estimated due date).  Your baby will be monitored until she is no longer having episodes of apnea or bradycardia.  The monitor records her events and your doctor can print out a reading.  Once your doctor sees that she has not had an episode in a certain length of time, she will be allowed to go off the monitor.  The good news is that apnea in premature infants is not permanent.  Once your baby’s lungs and central nervous system mature, the apnea will disappear and not return.

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