Did your little one come into this world a little early? It's normal to feel a little scared as a mother or father at such times. You may be wondering about your baby's breathing, especially. So, the breathing problem that we are going to talk about today is 'Apnea of Prematurity', which can occur in babies born before their due date, that is, before 37 weeks of gestation. Don't worry, this is usually temporary, and doctors know how to help with this.
What is Apnea of Prematurity?
Simply put, a premature baby's body parts, especially the systems that help them breathe, are not yet fully developed. Think about it, their tiny lungs, the breathing center in their brain, all of these are still 'learning'. So, they are not yet ready to breathe in a proper rhythm. Because of this, sometimes their breathing stops for a few seconds. This is what doctors call 'apneic spells'.
You may be scared when you hear this, "Oh, my baby isn't breathing properly?" But this condition is common among premature babies. And doctors know how to treat it. Your baby will spend some time in the Neonatal Intensive Care Unit (NICU). There, doctors and nurses will constantly monitor the baby's condition and give them treatments to help them breathe. When your baby is able to breathe normally on their own, without any help, they will be able to go home.
What are the symptoms of this condition?
Now let's see what symptoms a baby with Apnea of Prematurity may exhibit:
- Breathing has stopped for 15 or 20 seconds, maybe even longer.
- Slow heart rate. We call this 'bradycardia'.
- Low oxygen levels in the blood. This is called hypoxemia. This can cause the baby's skin, especially the lips and tongue, to appear blue, white, yellow-gray, or gray. This is called cyanosis.
Sometimes, a baby's breathing may stop for less than 15 seconds. However, if there is a slow heart rate (bradycardia) or low oxygen levels (hypoxemia), this is also considered a symptom of this 'apnea' condition.
Important: This should be distinguished from a condition called 'periodic breathing'. Periodic breathing is when babies have short pauses (less than 10 seconds) in their breathing. However, this does not cause a drop in heart rate or oxygen levels. After that, they breathe more rapidly. This is considered normal.
Why does this happen to our babies? (Causes of Apnea of Prematurity)
The main reason for this (Apnea of Prematurity) is, as mentioned earlier, that the baby's airways and the brain's breathing center are not yet fully developed. These two parts work together to allow the baby to breathe properly. Doctors divide these breathing pauses into three main types based on the cause:
- Obstructive Apnea
- Central Apnea
- Mixed Apnea
What is Obstructive Apnea?
What happens in this case is that there is an obstruction in the baby's airways. These airways are the ones that carry oxygen-rich air into the lungs and remove carbon dioxide from the lungs. So, for air to flow properly, these airways need to be open.
However, a premature baby's airway (especially the part that runs from the neck) may not be strong enough to keep it open all the time. That's when breathing can stop. It's like a small tube that doesn't open properly and gets stuck.
What is Central Apnea?
This happens when the brainstem, the center in the baby's brain that controls breathing, doesn't send signals at the right time. Normally, this brainstem sends signals to the baby's respiratory muscles – for example, the diaphragm and intercostal muscles. These muscles help pull air into and out of the lungs.
However, if the baby's brainstem isn't fully developed yet, the signals coming out of it aren't as orderly and reliable. That's why breathing can stop in the middle. It's as if the command from the brain to "breathe!" doesn't get through in time.
What is Mixed Apnea?
What happens in this case is that there is a problem with the baby's breathing path, and the signals from the brain's breathing control center are not coming through properly. It seems like both of the reasons mentioned above come together. This type of apnea is most commonly seen in babies born prematurely.
How do doctors recognize this?
This condition (Apnea of Prematurity) is diagnosed in the Neonatal Intensive Care Unit (NICU) where the baby is. This is the part of the hospital where babies who need special care and medical attention are kept. If your baby was born prematurely, he or she may have to stay in the NICU for a while before going home.
While the baby is in the NICU, doctors and nurses are constantly monitoring these things:
- Heart rate
- How to breathe
- Blood oxygen level
These monitors send signals if the baby's heart rate slows down or if breathing stops for a while. Doctors use the data from these machines and the nurses' observations to identify the condition.
Sometimes, these breathing pauses in newborns can be a symptom of other medical conditions. For example, metabolic disorders, brain bleeds, and infections. So, doctors first examine the baby to see if there are other medical conditions like these. Only after ruling out all other causes, can they definitively determine that this is Apnea of Prematurity.
Apnea of Prematurity is defined as a baby's breathing stops because they were born prematurely, and their nervous and respiratory systems are not yet fully developed. So, until their body is ready to do these things on its own, they need a little help breathing.
What is the treatment for this?
Treatment for Apnea of Prematurity is usually one or both of the following:
- Medications (often caffeine citrate)
- Assisting breathing
Why is caffeine added to this?
Caffeine citrate is a medication used to treat Apnea of Prematurity. Just like the jolt we get when we drink coffee in the morning, this medication stimulates the baby's nervous system. This 'wake-up' helps the baby's brain's breathing center and nerve cells send signals that regulate breathing.
This caffeine pill reduces the number of apneic spells that the baby has. It also helps reduce the duration of these pauses in breathing.
Breathing Support
Sometimes a baby's upper airway, the pharynx and larynx, needs a little help keeping them open. In this case, doctors often use a method called Continuous Positive Airway Pressure (CPAP). In this, the baby breathes on his own. However, air is sent through two small tubes placed in the baby's nostrils. This reduces the risk of respiratory arrest caused by airway blockage.
Imagine, when you blow a little air into a small balloon, it seems to inflate, this CPAP helps keep the airway open.
If your baby continues to have severe respiratory arrest, he or she may need 'mechanical ventilation'. This means that a machine (ventilator) will do the breathing for the baby until the baby's body can breathe on its own. This is only for a short time.
If my baby has this condition, what should I expect?
Apnea of Prematurity is a temporary condition . As the baby grows and develops, these symptoms will gradually decrease. Your baby may need to stay in the NICU for a few weeks, or even two to three months. There, he will receive treatment not only for breathing problems, but also for any other problems that may arise from being born prematurely.
The doctors will tell you how long the baby will need to stay in the NICU and what needs to happen to safely take the baby home.
Usually, doctors will determine a safe time to stop the baby's treatment. Then, after the treatment is stopped, they will observe how the baby's body responds to it. Before the baby can be sent home, they will need to be there for a few days without any breathing problems. The length of this "observation period" will depend on how premature the baby was and their overall health.
Most babies don't need continued monitoring after they go home. However, if your baby does need monitoring, your doctor will explain exactly what to do. If there is anything you are unsure about or if you have any concerns about caring for your baby at home, be sure to ask your doctor or nurse. They will give you all the information you need to get used to this new environment.
Apnea of Prematurity is a common condition in premature babies. However, knowing that it is common, it is not easy to be away from your newborn when you want to hold him/her. You will feel very lonely and sad while your baby is in the NICU. However, always remember that this is temporary.
The doctors and nurses in the NICU will help you find ways to spend time with your baby during this time. They will also give you information about how your baby's breathing is developing and when you can expect to be able to take your baby home.
Remember as a summary (Take-Home Message)
If your premature baby is experiencing apnea of prematurity, it can be really scary. But please remember:
- This is usually temporary. As the baby grows, his respiratory system also strengthens.
- Doctors know how to treat this. Your baby will receive the best care in the NICU.
- You are not alone. There are other parents who have had similar experiences, not just doctors and nurses. Don't hesitate to share your feelings and ask for help.
- Keep hope. You too will have the opportunity to go home with your baby in a few days.
Wishing your baby a speedy recovery!
` Premature birth, apnea, baby breathing, NICU, baby health, breathing difficulties, caffeine therapy
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