Courae

1. COLLEGE OF HEALTH SCIENCES SCHOOL OF
NURSING AND MIDWIFERY POSTGRADUATE
PROGRAM
SEMINAR PRESENTATION:-NEONATAL APNEA
by Deribew.A
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2. Course outline
Objective
Definition
Types of neonatal apnea
Etiology of neonatal apnea
Diagnosis of neonatal apnea
Management of neonatal apnea
Prevention of neonatal apnea
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3. Objectives
At the end of the session the learner will able to:-
Define neonatal apnea
Discuss on the Types of neonatal apnea
List the Etiology of neonatal apnea
Discuss on the Diagnosis of neonatal apnea
Discuss on Management of neonatal apnea
Identify Prevention method of neonatal apnea
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4. Neonatal Apnea
oApnea is defined as cessation of breathing for
longer than 20 sec, or for shorter duration in
presence of bradycardia(<100bpm), cyanosis and
hypoxemia(SPO2 <85%).
oUsually apnea for 20 seconds or longer is needed to
produce these clinical signs.
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5. Types of neonatal apnea
1. Central – total cessation of respiratory effort with
no evidence of obstruction (no respiratory efforts,
no airflow)
2. Obstructive – no airflow, despite respiratory
efforts
3. Mixed – often begins as central and later becomes
obstructive. The most common.
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6. Etiology
 Apnea is commonly occurs in premature new borns
related to immaturity of the respiratory control
system.
 generally begins 1 or 2 days after birth and called
apnea of prematurity (AOP).
 In term new borns, it occurs in association with
serious identifiable causes.
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7. Cont…
 Apnea occurring in first 24 hours and beyond 7 days
of life is more likely to have a secondary cause than
being AoP.
Secondary causes of apnea include:-
1. Temperature instability: hypothermia and
hyperthermia, especially frequent fluctuations in body
temperature
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8. Cont….
2. Metabolic: acidosis, hypoglycemia, hypocalcaemia,
hyponatremia, hypernatremia
3. Hematological: anemia, polycythemia
4. Neurological: intracranial infections, intracranial
hemorrhage, seizures, perinatal asphyxia, and placental
transfer of drugs such as narcotics, magnesium sulphate,
or general anesthetics
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9. Cont…
5. Pulmonary: respiratory distress syndrome (RDS),
pneumonia, pulmonary hemorrhage, obstructive airway
lesion, pneumothorax, hypoxemia, hypercarbia, airway
obstruction due to neck flexion.
6. Cardiac: congenital heart disease, hypo/hypertension,
congestive heart failure, patent ductus arteriosus
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10. Cont..
7.Gastro-intestinal: gastro esophageal reflux,
aspiration, abdominal distension, NEC
8. Infections: sepsis, pneumonia, meningitis.
AOP is a diagnosis of exclusion.
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11. PATHOGENESIS
Apnea of prematurity is a developmental disorder
that reflects physiologic rather than pathologic
immaturity of respiratory control.
the exact mechanisms responsible for apnea in
premature infants have not been clearly identified.
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12. Factors Implicated in the Pathogenesis of Apnea
of Prematurity
1. Central Mechanisms
Decreased central
chemosensitivity
Hypoxic ventilatory
depression
Upregulated inhibitory
neurotransmitters, e.g.,
GABA, adenosine
2.Peripheral Reflex Pathways
Decreased carotid body
activity
Increased carotid body
activity
Laryngeal chemoreflex
Excessive bradycardic
response to hypoxia
3. Others
Genetic predisposition
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14. Diagnosis
The diagnosis of apnea is usually made by
observing the breathing pattern, color and heart rate
of new born.
An oxygen saturation monitor will indicate a fall in
oxygen saturation when the infant has apnea.
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15. Management of AOP
General measures
Resuscitate patient first:-
Stimulate the baby by rubbing his chest or feet for
10 seconds
Suction mouth and nose
If the baby does not begin to breathe immediately,
position head in a neutral position and ventilate
using a bag and mask.
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16. Cont…
If oxygen saturations <90%, start oxygen
Check glucose level with glucometer and correct as
indicated
Maintain environmental temperature
Immediate investigations are blood sugar, PCV,
sepsis screening, electrolytes and cranial ultrasound
scan to rule out IVH.
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17. Cont…
Start CPAP with close monitoring especially if
recurrent apnea.
Treat the underlying cause: sepsis, anemia,
polycythemia, hypoglycemia, hypocalcemia,
respiratory distress syndrome (RDS).
KMC should be continued or started if baby is
stable.
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18. Cont..
Aminophylline – loading dose 8mg/kg Iv infusion
over 30 minutes
 Maintenance – 1.5 to 3mg/kg IV every 8 to 12 hours.
Caffeine – loading dose 20 to 25mg/kg of caffeine
citrate IV over 30 min or orally.
Maintenance --- 5 to 10 mg/kg per dose of caffeine
citrate IV slowly push or orally every 24hr.
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19. Prevention
About 25% of neonates <34 weeks have apnea of
prematurity.
Therefore, it is reasonable to start
caffeine/aminophylline prophylactically to all
premature infants of gestational age <32 weeks or
weight <1250g.
If caffeine is available this would be the first choice
over aminophylline.
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20. Cont…
Very low birthweight (<1500g) babies should receive
prophylactic caffeine/ aminophylline orally until they
reach 1.5kg or 34 weeks GA, whichever comes first.
Maintain normal hematocrit, electrolytes and PaO2
Avoid neck flexion and abdominal distension
KMC
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21. Dosages of caffeine citrate and aminophylline
Caffeine Dose:-
Loading dose: 20mg/kg caffeine citrate IV mainly or
NG/PO (depending on the circumstances) stat on
from birth on Day 1
Then maintenance: 5-10mg/kg/day caffeine citrate IV
or NG/PO given as once daily dose in the morning.
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22. Aminophylline dose (if caffeine citrate is not
available)
Loading dose: 5mg/kg aminophylline IV (or PO)
given slowly over 20min
Then maintenance: 2mg/kg /per dose twice daily
(IV or per oral PO) starting 24hours after loading
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24. Reference
Neonatal Intensive Care Unit Training Participant`s
manual Ministry of Health, Ethiopia January, 2024.
Eichenwald EC and AAP COMMITTEE ON FETUS
AND NEWBORN, Apnea of Prematurity, Pediatrics,
2016.
WHO neonatal-clinical-guidelines-2018-2021
Fanaroff and Martins Neonatal Perinatal Medicne 10th
edition.
neoFax drug monography summary 2020
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