Apnea of prematurity (AOP) is a common condition affecting premature infants where breathing temporarily stops for periods of 20 seconds or longer.
The condition occurs when babies are born before 37 weeks of pregnancy,
The breathing pauses occur because the brain area controlling breathing isn’t fully developed.
The likelihood of developing AOP is inversely related to gestational age – virtually all infants born before 28 weeks develop it, while 85% of babies born at 30 weeks and 20% of those born at 34 weeks are affected.
It’s one of the most common diagnoses in neonatal intensive care units.
AOP results from physiologic immaturity of respiratory control.
The process may be worsened by other neonatal diseases, including altered responses to low oxygen, high carbon dioxide, and changes in sleep states.
Treatment is recommended when apneic episodes are frequent, prolonged, require frequent stimulation, or are associated with slow heart rate and low oxygen levels.
Standard treatments include nasal continuous positive airway pressure (CPAP) and methylxanthine therapy.
Caffeine and other methylxanthines are highly effective in reducing apnea.
Caffeine is the respiratory stimulant of choice to prevent or treat apnea of prematurity.
Caffeine reduces exposure to mechanical respiratory support and supplemental oxygen and decreases the risk of bronchopulmonary dysplasia, severe retinopathy of prematurity, survival with disability at 18 to 21 months, and motor impairment at five and 11 years.
Extending caffeine usage beyond 33-35 weeks post menstrual age did not shorten hospital stay.
The condition usually resolves on its own over time, doesn’t cause brain damage, and healthy infants who’ve had AOP typically don’t develop more health or developmental problems than other babies.
Many premature babies outgrow AOP by what would have been their 36th week of pregnancy.
AOP can lead to complications like increased carbon dioxide levels and carries some increased risk of morbidity and mortality.