Apnoea of prematurity

Overview & Definition

Walk onto the neonatal unit at three in the morning and the question is almost always the same. A baby born at 26 weeks, now four days old, has set off the alarm — the monitor shows a flat breathing trace and a heart rate falling toward 70. The team moves through it from memory: a flick of the foot, a gentle rub, and the numbers climb back. This is apnoea of prematurity, the most common breathing disorder of the very preterm infant, and the skill lies not in the rescue but in deciding when the pause is benign immaturity and when it is sepsis in disguise. [4]

The definition examiners want is precise and worth memorising word for word. Apnoea of prematurity is a cessation of breathing lasting 20 seconds or longer, or a shorter pause accompanied by bradycardia (a heart rate below 80 beats per minute), central cyanosis, or an oxygen desaturation below roughly 80 to 85 percent. It is a diagnosis of developmental immaturity, made in an infant born before 37 weeks, emerging after the first 24 hours of life, and expected to resolve by 43 to 44 weeks postmenstrual age. Crucially, it is a label you can only apply once you have excluded the things that mimic it. [4] [12]

The distinction that catches candidates is the one between apnoea and periodic breathing. Periodic breathing is a benign immature pattern of at least three pauses, each lasting more than three seconds, separated by less than 20 seconds of normal breathing, with no bradycardia and no colour change. You reassure the parents and do not treat it. Apnoea, by contrast, carries physiological consequences and warrants intervention, because the recurrent dips in oxygen that accompany it are what you are really trying to prevent. [4]

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