seminar presentation2 on apnea (1) (1).pptx

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1. COLLEGE OF HEALTH SCIENCES SCHOOL OF NURSING AND MIDWIFERY POSTGRADUATE PROGRAM SEMINAR PRESENTATION:-NEONATAL APNEA by Deribew.A 4/25/2024 1

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 4/25/2024 2

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 4/25/2024 3

4. Neonatal Apnea Apnea 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%). Usually apnea for 20 seconds or longer is needed to produce these clinical signs. 4/25/2024 4

5. Types of neonatal apnea Central – total cessation of respiratory effort with no evidence of obstruction (no respiratory efforts, no airflow) Obstructive – no airflow, despite respiratory efforts Mixed – often begins as central and later becomes obstructive. The most common. 4/25/2024 5

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. 4/25/2024 6

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 4/25/2024 7

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 4/25/2024 8

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 4/25/2024 9

10. Cont.. 7. Gastro-intestinal: gastro esophageal reflux, aspiration, abdominal distension , NEC 8. Infections : sepsis, pneumonia, meningitis . AOP is a diagnosis of exclusion. 4/25/2024 10

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 . 4/25/2024 11

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 4/25/2024 12

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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 . 4/25/2024 14

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. 4/25/2024 15

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. 4/25/2024 16

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. 4/25/2024 17

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. 4/25/2024 18

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 <3 2 weeks or weight <1 2 5 0g. If caffeine is available this would be the first choice over aminophylline. 4/25/2024 19

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 PaO 2 Avoid neck flexion and abdominal distension KMC 4/25/2024 20

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. 4/25/2024 21

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 4/25/2024 22

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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 10 th edition. n eoFax drug monography summary 2020 4/25/2024 24

25. THANK YOU 4/25/2024 25