III. APNEA AND BRADYCARDIA
Apnea is defined as respiratory pause lasting 20 seconds--or less if associated with
bradycardia (HR <100). The risk of apnea decreases with increasing gestational age.
Apnea may be classified as follows:
- Central apnea: due to immaturity in brain stem & respiratory center. There is no
evidence of either respiratory effort or obstruction - Obstructive apnea: due to pharyngeal collapse. Breathing movements are seen
without air movement - Mixed apnea: most common form of apnea. Central apnea is followed by
obstructed respiratory efforts. - Periodic breathing: IS NOT TRUE APNEA. Characterized by a repeating sequence
(>=3) of prolonged pauses (>=3s) in breathing with periods of normal respiration (<20s).
While commonly seen in nearly all infants, careful clinical assessment to rule out true
apnea is necessary. This is generally benign and requires no treatment.
If apnea is recurrent, consider checking CBC (impending sepsis or anemia), electroytes,
calcium, magnesium and glucose, a blood gas, CXR, head ultrasound, or EEG. Review
the medications. Review timing to apnea to determine whether apnea may be due to
reflux.