Apnea of ??prematurity is by pauses in breathing> 20 s or breaks <20 s, with bradycardia (<80 beats / min), central cyanosis and / or O2 saturation <85% in neonates <37 weeks and no underlying cause for apnea are defined. The cause may be a Immature CNS (central) or an obstruction of the airways. The diagnosis is made by a multi-modal monitoring of respiration. The treatment of central apnea is performed with stimulants and obstructive apnea with top bearing. The prognosis is excellent; apnea stops in most newborns with 37 weeks.
About 25% of preterm (premature infant child) have apnea of ??prematurity, which begins and usually 2-3 days after birth, rarely on the first day. An apnea that develops> 14 days after birth in an otherwise healthy child who has a serious illness except prematurity apnea way (eg. As sepsis [(sepsis in neonates)]). The risk increases with a low gestational age.
Apnea of ??prematurity is by pauses in breathing> 20 s or breaks <20 s, with bradycardia (<80 beats / min), central cyanosis and / or O2 saturation <85% in neonates <37 weeks and no underlying cause for apnea are defined. The cause may be a Immature CNS (central) or an obstruction of the airways. The diagnosis is made by a multi-modal monitoring of respiration. The treatment of central apnea is performed with stimulants and obstructive apnea with top bearing. The prognosis is excellent; apnea stops in most newborns with 37 weeks. About 25% of preterm (premature infant child) have apnea of ??prematurity, which begins and usually 2-3 days after birth, rarely on the first day. An apnea that develops> 14 days after birth in an otherwise healthy child who has a serious illness except prematurity apnea way (eg. As sepsis [(sepsis in neonates)]). The risk increases with a low gestational age. Pathophysiology apnea of ??prematurity is a developmental disorder that is caused by immaturity of the neurological and / or mechanical function of the respiratory system. Apnea can be characterized a mixture of both (most common), the central apnea is caused as a central Obstructive by immature Mark respiratory control centers. The specific pathophysiology is not completely understood, but seems to be a number of factors to include, including abnormal responses to hypoxia and hypercapnia. An obstructive apnea is caused by airway obstruction, neck flexion is approached the facing soft tissues in the hypopharynx, obstruction of the nose or laryngospasmischen Reflex The mixed apnea is a combination of central and obstructive apnea. All forms of apnea can cause hypoxia, cyanosis and bradycardia in prolonged apnea. Among the children suffering from SIDS (Sudden Infant Death Syndrome (SIDS)) die, 18% premature babies, but the apnea of ??prematurity appear to be a forerunner of SIDS. The periodic breathing are repeat cycles of 5 to 20 seconds norrmaler breathing, alternating with short (<20 seconds) periods of apnea. This phenomenon is common among premature babies and has little or no clinical significance. Diagnosis Clinical evaluation Cardiorespiratory monitoring, documentation of physiological parameters exclusion of other causes (eg. As hypoglycemia, sepsis, intracranial hemorrhage) Although it is often attributed to the immaturity of the respiratory control system, prematurity apnea may be a symptom of infections and disorders of the metabolism, thermoregulation, his respiration, the heart or the CNS Funktionn. A thorough history, physical examination and possibly laboratory tests before the preterm delivery is suspected as the cause of apnea should be made. It is no longer believed that gastroesophageal reflux disease causes (Gerd Gastroesophageal reflux in infants) prematurity apnea, so the presence of GERD rather than an explanation of apnea should be considered. The diagnosis of sleep apnea is usually provided by visual observation or by continuous use of cardio-respiratory impedance type monitors during the assessment and ongoing care of premature babies. Multi-track documentation of multiple physiological parameters (eg. As chest wall movement, air flow, O2 saturation, heart rate, electrical activity of the brain) over 24 h can assist in the diagnosis and help in the planning and monitoring of treatment. However, these more advanced tests are not necessary for the discharge planning. Prognosis For most premature babies hear the episodes of apnea on after the 37th week of pregnancy. Apnea may persist in infants with extremely early gestational age (z. B. 23-27 weeks) over several weeks. Rarely leads to death. Treatment stimulation treatment of the underlying disease respiratory stimulants (z. B. caffeine) If an apnea is noted either by observation or by the monitor alarm, the children are stimulated. This is sometimes sufficient. If breathing is not used, care should be taken for a mask ventilation or mouth-to-mouth resuscitation (Restoring and Backing up the airways: respiratory and airway devices). For children who are cared for at home, the doctor should be contacted, is when an apnea episode occurred but stopped after stimulation. Is an intervention on the stimulation also necessary, the child should be taken to hospital and examined. Frequent or severe episodes should be assessed quickly and thoroughly, and the identifiable causes are treated. If no infection or other treatable disorder is discovered, are indicated for frequent or severe episodes of respiratory stimulants; these are characterized by hypoxemia, cyanosis, bradycardia or a combination thereof. Caffeine is the safest and the most frequently used Atemstimulanzium. It can be used as caffeine base (initial dose 10 mg / kg maintenance dose of 2.5 mg / kg PO every 24 h) or Caffeine citrate or caffeine salt, which consists of 50% caffeine (initial dose 20 mg / kg maintenance dose of 5-10 mg / kg po all 24 h), are given. Caffeine is preferred because it is easier to administer, has fewer side effects, has a larger Anwendungsprektrum and requires less monitoring. Treatment is continued until the infant 34-35 weeks old and appeared no apnea episode for 5-7 days at which had to be intervened. Monitoring is continued until the infant for a period of 5-10 days does not require treatment of apnea. If the apnea episodes continue despite respiratory stimulants, the newborn should CPAP (breathing assistance in neonates and infants: Continuous Positive Airway Pressure (CPAP)) is obtained, starting from 5-8 cm H2O pressure. In nichtbehandelbaren apnea episodes must be intubated and ventilated. The dismissal practices vary. Some therapists observe the child after completion of treatment a further 7 days, others dismiss the child with caffeine when the treatment appears successful. Prevention Domestic monitoring Stationary high-risk children who no clinically significant cardiopulmonary symptoms (eg. As apnea> 20 seconds, apnea accompanied by central cyanosis, s apnea with a heart rate <80> 5) show during 3 to 10 days of continuous cardiorespiratory monitoring can be discharged home without understanding a monitor safely. A cardiorespiratory monitor and / or oral caffeine can sometimes be prescribed for home use, to shorten the hospital stay for infants who are otherwise ready for the dismissal, but still have cardiopulmonary symptoms, but stop again without intervention. However, infants have become the events that require intervention, including stimulation, not released from the hospital. Parents what to do in case of alarm situations should learn how to deal with the devices properly (eg. As cardiopulmonary resuscitation Reanimation- Cardiopulmonary in infants and children), and how they can log the events. Telephone support around the clock, triage and outpatient follow-up visits with decision-making on a further continuation of the use of the monitor should be made available. Monitors that can store information about events that are to be preferred. Parents should be informed that has not been shown that cardiorespiratory monitors for home use, the incidence of SIDS (Sudden Infant Death Syndrome (SIDS)) or apparent life-threatening events (ALTE apparently life-threatening event (ALTE)) reduced. Tips and risks, it has not been shown that cardiorespiratory monitors for home use reduce the incidence of SIDS or old. Positioning infants should always be placed to sleep on their backs. The child’s head in center position and straight neck or slight hyperextension storage can be helpful in preventing obstructive apneas. All premature babies, especially those who have a premature infant apnea when they sit in the car seat, an increased risk of apnea, bradycardia and not enough O2 saturation. They should be subjected to prior to dismissing a car seat test. Important points of prematurity apnea is caused by immaturity of neurological and / or mechanical function of the respiratory system. The babies have breathing pauses> 20 Seconds or breaks <20 seconds in conjunction with bradycardia (<80 beats / min) and / or O2 saturation <85%. The diagnosis is made by observation and other heavier causes of apnea (z. B. infectious, metabolic, thermoregulatory, respiratory, cardiac or CNS disorders) are excluded. Respiration is monitored and physical Stimuation is administered against apnea. If breathing does not start, will be provided for a mask ventilation or mouth-to-mouth resuscitation. Oral caffeine is given newborns who have recurrent episodes.