Apnea of prematurity without pathophysiology.pptx

Apnea of prematurity brief presentaion
Correction: mixed apnea mainly obstructive that turns central

1. Apnea of prematurity By : Menna Doubal

2. Definition : Apnea is defined as the cessation of breathing more than 20 seconds or less when a ssociated with bradycardia (heart rate ,100 beats per minute, associated with desaturation)

3. Incidence The incidence of AOP has an inverse correlation to the gestational age (GA ): 7% of neonates with a GA of 34-35 weeks 15% of neonates with a GA of 32-33 weeks 54% of neonates with a GA of 30- 31 weeks nearly 100% of neonates with a GA of < 29 weeks or weighing less than 1,000 g

4. Periodic breathing Periodic breathing is a normal variation of breathing found in premature and full-term infants . P auses of breathing for no more than 5 to 10 seconds at a time M ay have minor oxygen desaturation and bradycardia F ollowed by a series of rapid breathing episodes R eturn to normal breathing without stimulation. It occurs mainly during quiet sleep It is absent in the first few days of life M ore frequent at 2 to 4 weeks of age U sually gone by 6 months .

5. AOP usually presents on days 2 to 7 . It usually resolves by 36 to 37 weeks of postmenstrual age (PMA ). If apnea presents in the first 24 hours of life or after day 7 is more likely to be associated with secondary causes than AOP.

6. Classification Central apnea Caused by poorly developed neurological control Respiratory movement is absent 2. Obstructive apnea Caused by upper airway obstruction, usually at the pharyngeal level Respiratory movement continue initially then stop Mixed apnea occurs when airway obstruction with inspiratory efforts precedes or follows central apnea . (usually central followed by obstructive)

7. Etiology

8. Monitoring and evaluation All infants 35 weeks gestational age and less should be monitored for apneic spells for at least the first week after birth because of the risk of apneic spells in this Group. Monitoring should continue until no significant apneic episode has been detected for at least 5 days . When a monitor alarm sounds, one should respond to the infant, not the monitor , checking for bradycardia , cyanosis , and airway obstruction . Most apneic spells in preterm infants respond to tactile stimulation . Infants who fail to respond to stimulation should be ventilated during the spell with bag and mask .

9. If there is increase in frequency or severity of apnea or bradycardia Screen for

10. Treatment General measures Treatment of underlying cause Care to avoid apnea-triggering actions (Suctioning of the pharynx) Positions of extreme flexion or extension of the neck should be avoided to reduce the likelihood of airway obstruction.

11. Primary apnea of prematurity is a disease of exclusion and may not require treatment unless pauses are: Frequent (>8 in 12 hours) Severe (>2 episodes per day requiring ppv )

12. Pharmacological Caffeine Loading dose 20 mg/kg of caffeine citrate Maintenance 5 to 10 mg/kg in one daily dose beginning 24 hours after the loading dose.

13. Non-Pharmacological CPAP Nasal continuous positive airway pressure (CPAP) at moderate levels

14. Mechanical ventilation may be required if the other interventions are unsuccessful.

15. Discharge considerartions We typically require that preterm infants have no apnea spells recorded for 5 to 7 days prior to discharge , Because of the long half - life of caffeine (50 to 100 hours) and even longer effects in some infants, we typically start this “countdown” period several days after caffeine is stopped.

16. Resources CLOHERTY AND STARK’S MANUAL OF NEONATAL CARE