Paeds Cases · fetal-neonatal-and-perinatal
Apnoea of prematurity — clinical case
Clinical case of a very preterm infant with recurrent apnoea who deteriorates at one week of age, illustrating exclusion of secondary causes and caffeine-first management.
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RACP DCEMRCPCH ClinicalABP General Pediatrics
Prompt
A 7-day-old girl born at 25 weeks and 6 days (birth weight 690 g) has been managed on the neonatal unit for respiratory distress syndrome and was commenced on caffeine citrate at day 2. She is now having increasing numbers of apnoeic episodes — eight in the last eight hours, each lasting 20 to 25 seconds with desaturation to 75 percent and bradycardia to 70. She is mildly hypothermic at 36.2 degrees and has had two residual gastric aspirates.
Case summary
This extremely preterm infant presents with a change in her apnoea pattern at one week of age — more frequent, more severe events, with the added features of mild hypothermia and increased gastric residuals. The key clinical insight is that new or worsening apnoea after a stable period is a sentinel for late-onset sepsis or necrotising enterocolitis, not simply immaturity that has outgrown its caffeine dose. [2]
References3ShowHide
- [1]Schmidt B, Roberts RS, Davis P, et al Caffeine therapy for apnea of prematurity. N Engl J Med, 2006.PMID 16707748
- [2]Erickson G, Dobson NR, Hunt CE Immature control of breathing and apnea of prematurity: the known and unknown. J Perinatol, 2021.PMID 33712716
- [3]American Academy of Pediatrics Committee on Fetus and Newborn Apnea, sudden infant death syndrome, and home monitoring. Pediatrics, 2003.PMID 12671135