RT Book, Section
A1 Gomella, Tricia Lacy
A1 Cunningham, M. Douglas
A1 Eyal, Fabien G.
A1 Tuttle, Deborah J.
SR Print(0)
ID 1107527639
T1 Apnea and Bradycardia (“A's and B's”)
T2 Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs, 7e
YR 2013
FD 2013
PB McGraw-Hill Education
PP New York, NY
SN 9780071768016
LK accesspediatrics.mhmedical.com/content.aspx?aid=1107527639
RD 2024/04/24
AB An  infant  has  just  had  an  apneic  episode  with  bradycardia.  Apnea  is  the  absence  of  breathing  for  >20  seconds  or  a  shorter  pause  (>10  seconds)  associated  with  oxygen  desaturation  or  bradycardia  (50%  of  infants  50%).Periodic  breathing.  Three  or  more  respiratory  pauses  lasting  >3  seconds  separated  by  normal  respiratory  intervals  not  >20  seconds  and  not  associated  with  bradycardia.  Periodic  breathing  can  occur  in  2–6%  of  healthy  term  neonates  and  in  up  to  25%  of  preterm  infants.Apnea  of  infancy  (AOI).  American  Academy  of  Pediatrics  (AAP)  definition:  “an  unexplained  episode  of  cessation  of  breathing  for  20  seconds  or  longer  or  a  shorter  respiratory  pause  associated  with  bradycardia,  cyanosis,  pallor,  and/or  marked  hypotonia”  in  an  infant  >37  weeks'  gestational  age.Apnea  of  prematurity  (AOP).  Sudden  absence  of  breathing  that  lasts  at  least  20  seconds  or  is  associated  with  bradycardia  or  cyanosis  (oxygen  desaturation)  in  an  infant  <37  weeks'  gestational  age.  It  is  most  commonly  central  or  mixed  apnea.  AOP  is  a  developmental  disorder  usually  of  physiologic  immaturity  of  respiratory  control  but  other  diseases  may  contribute.  AOP  may  be  hereditary.  AOP  usually  presents  on  days  2–7.  If  apnea  presents  in  the  first  24  hours  of  life  or  after  day  7,  it  is  very  unlikely  to  be  AOP.  Note:  Apnea  of  prematurity  is  a  diagnosis  of  exclusion.Persistent  apnea.  Apnea  persists  in  a  neonate  ≥37  weeks  postmenstrual  age.  It  usually  occurs  in  infants  born  at  <28  weeks'  gestation.Secondary  causes  of  apnea.  Apnea  that  has  a  specific  cause  (eg,  sepsis,  anemia,  asphyxia,  temperature  instability,  pneumonia,  and  others).  Remember  immaturity  can  worsen  any  apnea  that  is  associated  with  a  specific  cause.