The main reason for spontaneous respiratory arrest is the immaturity of the central and peripheral structures of the nervous system. Myelination of nerve fibers that provide the act of breathing, normally ends by 36-37 weeks of gestation.
All babies born earlier in pregnancy are at risk of developing apnea of prematurity. In addition, respiratory arrest can be associated with direct damage to the brain structures due to intrauterine infections, meningitis, intraventricular hemorrhages and other conditions that are common in premature babies.
It is known that newborns spend most of their time in sleep. Premature babies sleep about 80% of the time a day. In the phase of REM sleep, the overall immaturity of the nervous system is superimposed on a characteristic reduction in the frequency of respiratory movements characteristic of a sleeping child and an even greater weakening of the central control of respiration.
Also, premature babies have a pathological reaction to hypoxia. The lack of oxygen causes them to have bradycardia and a decrease in respiration instead of a compensatory increase and an increase in respiratory movements. Rarely, apnea of prematurity is caused by an upper airway obstruction. This is usually associated with weakness and underdevelopment of the muscle frame.
Classification of premature apnea
There are three forms of apnea premature: central, obstructive and mixed. Central and mixed respiratory arrest mechanisms occur in 85-90% of cases. In central apnea, seizures are associated with the immaturity of the nervous system.
In apnea of mixed genesis, an upper airway obstruction occurs, which occurs after central respiratory arrest or contributes to it. The share of apnea premature, associated exclusively with obstruction, accounts for about 10-15% of cases. Also conventionally share idiopathic apnea and respiratory arrest, developing on the background of various diseases (sepsis, anemia, meningitis, etc.).
Symptoms of apnea premature
You can notice signs of respiratory failure by changing the color of the baby’s skin. Apnea is accompanied by cyanosis or pallor of the skin. Anxiety is absent; on the contrary, depression of the nervous system is noted. The condition is often accompanied by symptoms of concomitant diseases.
Seizures may occur, including loss of consciousness. Signs of intoxication are characteristic of infectious pathologies: pneumonia, meningitis, sepsis of any etiology, etc. In the case of idiopathic apnea, there are no premature symptoms other than respiratory arrest. Since the state of prematurity in most cases requires respiratory support, apnea can be recorded with special equipment.
Diagnosis of premature apnea
Clinical signs are indirect and not always visible to the pediatrician. The basis of the diagnosis is the data of the hardware monitoring. Apnea of prematurity is diagnosed by reducing the saturation to 85% and below. The duration of the attack is at least 20 seconds.
Seizures of shorter duration can also be considered as apnea of prematurity, if accompanied by bradycardia with a heart rate of 100 beats / min and below. You can visually notice the cessation of breathing by weakening or stopping contractions of the intercostal muscles and the diaphragm. The same feature makes it possible to distinguish between apnea of the central and obstructive genesis, since in the latter case the respiratory movements do not stop.
In all cases of respiratory arrest, it is necessary to ascertain the causes of apnea. Since most often there is a central and mixed genesis of apnea of prematurity, the diagnosis of the state of the brain.
Neurosonography is used, according to indications a lumbar puncture is performed, which allows to detect signs of inflammation, intraventricular hemorrhage, and also to take material for planting in order to determine the causative agents of intrauterine infections. Brain tumors are excluded, especially stem localization, since it is in the brain stem that the respiratory center is located. Pneumonia is confirmed radiographically. Signs of nasal breathing disorders can be detected with anterior rhinoscopy.
Treatment of premature apnea
The treatment is carried out in the intensive care unit. The type of oxygen support is determined individually. Deep premature babies are always on the ventilator. The therapy uses central respiratory stimulants. Methylxanthines are also prescribed to prevent airway obstruction. Perhaps the use of surfactant to accelerate the maturation of the alveolar epithelium. Therapy of other conditions associated with prematurity.
If necessary, antibiotics are introduced, anti-shock therapy is carried out. Extract is possible after reaching the postconceptual age of 36-37 weeks. The criterion of recovery is the absence of apnea premature for 7-10 days.
Apnea premature – attacks of spontaneous respiratory arrest in premature babies due to the morphological and functional immaturity of certain brain structures. It is manifested by the cessation of breathing for at least 20 seconds. Accompanied by a slowing of the heartbeat, a decrease in blood saturation and a change in the color of the skin (cyanosis or pallor). Apnea premature diagnosed by the results of hardware monitoring. The fact of respiratory failure is also confirmed by the absence of respiratory movements. Treatment includes oxygen support, drug stimulation of breathing, acceleration of the maturation of the structures of the bronchial tree.
Apnea of prematurity occurs in 25-50% of newborns born before the normal gestational age (37-42 weeks). A similar condition is the so-called periodic breathing, which is characterized by a shorter duration of seizures than in apnea of prematurity.
- It is important to understand that respiratory arrest in premature babies occurs with a high degree of probability, and the state of prematurity itself is extremely important for pediatrics, because, along with apnea, entails many other risks to the child’s life. This is especially true of children born before the 30th week of gestation.
In addition, respiratory arrest is very difficult to diagnose in the absence of appropriate equipment, and the long stay of the child on the ventilator is also fraught with negative consequences.