Apnoea of prematurity
Immature respiratory control in the preterm infant (central ± obstructive)
Overview
Pauses in breathing (>20 seconds, or shorter with bradycardia/desaturation) due to immature central respiratory control in PRETERM infants. A diagnosis of exclusion — apnoea in a neonate must first prompt a search for an underlying cause (sepsis, hypoglycaemia, IVH, NEC, anaemia, temperature). Managed with caffeine, gentle stimulation and respiratory support.
Recognise
- Recurrent apnoeic pauses (>20 s, or with bradycardia/desaturation) in a preterm infant
- Central (no effort) ± obstructive (effort against a closed airway); resolves as the infant matures
- Must exclude an underlying precipitant before attributing to prematurity
Red flags
- NEW apnoea (especially in a previously stable baby) → exclude SEPSIS, NEC, IVH, hypoglycaemia, anaemia — do not assume it's 'just prematurity'
- Severe/frequent events needing escalating support
Differentials & how to tell them apart
Investigations
Investigate for a cause (FBC/CRP/cultures for sepsis, glucose, cranial USS, consider NEC); monitoring (saturations/apnoea monitor).
Management
Exclude a cause → caffeine + respiratory support
- 1First EXCLUDE an underlying cause (sepsis, NEC, IVH, hypoglycaemia, anaemia). If apnoea of prematurity: caffeine citrate, gentle stimulation, and CPAP/respiratory support as needed.Gate: New or worsening apnoea must trigger a sepsis/NEC/metabolic work-up — do not assume prematurity; caffeine is the pharmacological mainstay
- 2Caffeine until mature; monitor; treat any identified cause; resolves with maturity.
Key points
Preterm apnoeic pauses = apnoea of prematurity ONLY after excluding sepsis/NEC/IVH/hypoglycaemia/anaemia — apnoea is often the first sign of those. Treat with caffeine.
Monitor & prognosis
Apnoea/saturation monitoring; resolution with maturity.
Resolves with maturity.
Source: RCPCH; BAPM