Infantile Apnoea

Infantile apnoea is a breathing condition where babies stop breathing for periods of time during sleep or rest, often accompanied by changes in heart rate, skin color, or muscle tone.

Table of contents

• What is infantile apnoea?
• Types of infantile apnoea
• What causes infantile apnoea?
• Signs and symptoms
• How is infantile apnoea diagnosed?
• Treatment options
• What to expect

What is infantile apnoea?

Infantile apnoea is when a baby stops breathing for a certain period of time. This can happen in babies of any age, but it is most common in babies born before 37 weeks of pregnancy (premature babies)^[1]. The more premature a baby is, the more likely they are to have apnoea^[3].

In full-term babies (those born after 39 weeks), apnoea means a pause in breathing that lasts 20 seconds or longer^[2]. For premature babies, apnoea is defined as a sudden stop in breathing that lasts at least 20 seconds or is accompanied by a slow heart rate or low oxygen levels^[1]. Shorter pauses can also be considered apnoea if they occur along with other warning signs like changes in skin color or heart rate^[2].

It is important to understand that very brief pauses in breathing (5 to 10 seconds) are normal in babies and are called periodic breathing. This usually appears during the age of two to four weeks and goes away by six months of age^[1]. Periodic breathing does not cause changes in heart rate or skin color, and babies start breathing again on their own^[2].

Most babies outgrow apnoea by the time they are one year old^[2]. Infantile apnoea should not be confused with sudden infant death syndrome (SIDS). Unlike SIDS, doctors can sometimes identify why apnoea happens and can recommend treatment^[2].

Types of infantile apnoea

There are three main types of apnoea in babies, based on what causes the breathing to stop^[1].

Central apnoea happens when the baby’s brain does not send the right signals to the breathing muscles. The respiratory center in the brain is not yet mature enough to control breathing properly. In this type, both breathing effort and airflow stop at the same time^[1][3]. Central apnoea is common in premature babies because their nervous system is still developing^[3].

Obstructive apnoea occurs when something blocks the baby’s airway, making it difficult or impossible for air to pass through. The baby tries to breathe, and you may see chest movement, but no air flows in or out^[1][3]. This can happen when the airways are not developed enough to stay open, or when the baby’s position causes the airway to close^[3].

Mixed apnoea is a combination of both central and obstructive types. It usually starts with central apnoea, followed by an airway obstruction. This is the most common type of apnoea in premature babies^[1][3].

What causes infantile apnoea?

The causes of infantile apnoea vary depending on the baby’s age and development. The most common reason is simply that the baby was born too early. Premature babies, especially those born before 28 weeks of pregnancy, often have apnoea because the parts of their brain and body that control breathing are not fully developed yet^[1].

There are many other possible causes of apnoea in babies^[2]:

• Brain immaturity – The brain has not developed enough to send the correct signals to tell the body when to breathe.
• Heart problems – The heart may not pump enough blood to the brain to trigger breathing signals.
• Infections – Infections in the urinary system, lungs, or brain can cause apnoea.
• Acid reflux – When food and stomach juices come back up into the tube leading from the mouth to the stomach (the esophagus), it can trigger apnoea.
• Lung disease – Breathing problems or lung conditions can lead to apnoea.
• Low oxygen in the blood (anemia) – When the blood does not carry enough oxygen, apnoea can occur.
• Genetic problems – Some babies are born with conditions that make them more likely to have apnoea.

Other factors that can contribute to apnoea include problems with the brain (such as bleeding or injury), heart and blood vessel issues, certain medications, body temperature problems, and pain^[7]. Sometimes, doctors cannot find a specific reason for the apnoea^[2].

Babies with certain medical conditions are at higher risk. These include babies with Down syndrome, cleft palate, cerebral palsy, or facial differences^[3]. Being overweight or exposed to tobacco smoke can also increase the risk^[3].

Signs and symptoms

Parents and caregivers should watch for certain warning signs that may indicate their baby has apnoea. These symptoms can happen during sleep or while the baby is resting^[2].

The main signs of apnoea include^[2]:

• Not breathing for 20 seconds or longer
• Skin color becomes blue or very pale, especially around the lips or nose (cyanosis)
• The heart beats more slowly than normal, less than 80 times per minute (called bradycardia)
• The baby becomes very limp or floppy

Symptoms often appear most frequently during rapid eye movement (REM) sleep, which is a stage of deep sleep^[3]. If a baby has sleep apnoea, they will have difficulty breathing during daytime naps as well, not just at night^[8].

Parents may also notice that their baby snores loudly, gasps for air, chokes, or has noisy breathing. While it is normal for babies to squirm and cry, infants do not typically snore^[8].

During the day, babies with apnoea may show other problems. They might be very irritable, have trouble paying attention, behave poorly, or seem excessively sleepy. Some babies may experience bedwetting, headaches in the morning, or a dry mouth^[22].

How is infantile apnoea diagnosed?

To diagnose infantile apnoea, doctors need to examine the baby and perform certain tests. The baby will likely be admitted to the hospital for observation and testing^[2].

The main test used to diagnose sleep apnoea in babies is called a polysomnogram, or sleep study. This test takes place overnight, either at a sleep center or in the hospital. During the sleep study, sensors are placed on the baby’s body to monitor brain waves, breathing patterns, snoring, oxygen levels, heart rate, and muscle activity while the baby sleeps^[4][8]. This helps doctors detect problems and determine what type of apnoea the baby has.

It is important to make sure the sleep study is done at a facility that is accredited for children, because the way sleep studies are interpreted in babies is different from adults^[8].

The doctor will also perform a physical examination, looking at the baby’s head, neck, nose, mouth, and tongue to check for any blockages or structural problems^[4]. Blood tests may be done to check for infections, blood counts, or imbalances in body chemicals^[2]. Additional tests might include measuring oxygen levels in the blood or taking X-rays to look for problems in the lungs, heart, or airways^[9].

Doctors will also try to determine if there is an underlying medical condition causing the apnoea, such as an infection, heart problem, or lung disease. This helps them create the best treatment plan for the baby^[2].

Treatment options

Treatment for infantile apnoea depends on how severe the condition is and what is causing it. If the apnoea is caused by another medical problem, such as an infection or heart condition, doctors will treat that problem first^[6].

For mild episodes of apnoea, gentle stimulation may be enough. This can include gently tapping the baby’s foot or rubbing their back to remind them to breathe^[6][11]. If the baby’s airway is blocked, repositioning the baby’s head and neck can help open the airway^[11].

Many babies with apnoea receive medication. One common treatment is caffeine citrate, which is given by mouth or through a vein. This medicine helps stimulate the baby’s nervous system and helps keep them breathing^[5][6]. Caffeine also relaxes the smooth muscles in the lungs and stimulates the heart to work better^[6].

If medication and positioning do not work well enough, babies may need breathing support. This can include^[6][11]:

• High-flow nasal cannula – A device that delivers air through tubes placed in the baby’s nostrils
• Nasal continuous positive airway pressure (CPAP) – A machine that gently blows air through a mask on the baby’s nose or nose and mouth to keep the airway open
• Mechanical ventilation – In more severe cases, a machine breathes for the baby

In some cases, surgery may be recommended. If the baby has enlarged tonsils or adenoids (tissue at the back of the nose) that are blocking the airway, these can be removed through a surgery called adenotonsillectomy^[12].

Some babies are sent home with a home apnoea monitor. This is a device that continuously watches the baby’s breathing and heart rate. An alarm goes off if there are any problems, alerting parents to check on their baby^[10].

What to expect

Most babies with infantile apnoea get better as they grow and their bodies mature. The breathing control centers in the brain develop over time, and apnoea usually goes away on its own^[5]. For premature babies, apnoea typically ends once they reach the age they would have been if born full-term^[5].

Most infants outgrow apnoea by the time they are one year old^[2]. Once the apnoea goes away, it usually does not come back^[5].

While babies are being treated, they often stay in the neonatal intensive care unit (NICU) of the hospital, where they can be closely monitored^[5]. Healthcare providers watch the baby’s vital signs and provide treatments to support breathing until the baby is ready to breathe normally on their own.

Parents should work closely with their baby’s healthcare team to understand the treatment plan and learn how to care for their baby at home if needed. If the baby goes home with a monitor or special equipment, parents will receive training on how to use it and what to do if the alarm goes off^[10].

It is important to keep all follow-up appointments with the doctor to make sure the baby is developing well and that the apnoea is improving. With proper care and monitoring, most babies with infantile apnoea grow up healthy without long-term problems.