All About Apnea Cause Types Clinical Features Investigation Management

Apnea.

Cessation of respiration more than 20 seconds with or without bradycardia and cyanosis is called apnea.

Causes of apnea.

SHANTONA.
S-Seizure, sepsis.
H-Hypoglycemia, Hypocalcaemia, Hypomagnesaemia.
A- Apnea of prematurity.
N- Necrotizing enterocolitis.
T- Temperature instability- hypo or hyperthermia.
O- Obstruction of the air way-aspiration.
N-Na+ disorder- hypo or hypernatremia.
 A-air-way infection or pneumonia.

System wise causes of Apnea.

CNS cause-
꞉ Seizure.
꞉ Intracranial hemorrhage.
 ꞉ Cerebral malformation.

꞉ Meningitis.
Air-way cause-
꞉ Air-way obstruction.
꞉ Aspiration.
  Metabolic cause-
꞉ Hypoglycemia.

꞉ Hypocalcaemia.
꞉ Hypomagnesaemia.
Infectious cause-
 ꞉ Septicemia.
꞉ Necrotizing enterocolitis.

꞉ Pneumonia.

Electrolyte imbalance-
꞉ Hyponatremia.

꞉ Hypernatremia.
Apnea of prematurity
: Hypothermia.
: Hyperthermia.

Types of apnea.

a. Central apnea- problem at respiratory center in the brain stem. Respiratory effort is absent but air entry is normal.
b. Obstructive apnea-Air-way problem. Respiratory effort is present but air entry is poor or absent.
c. Mixed apnea- in the same episode both central and mixed apnea present.

Recurrent apnea.

Apnea occurring more than 3 times per hour is called recurrent apnea.

Management of Apnea.

a. Air way care-
꞉ Neutral position.
꞉ Clean air-way- by gentle O-P suction if air way obstruction is present. Vigorous suction may causes bradycardia.
꞉ Initiation of respiration by tactile stimulation-Slapping or flickering on the sole, rubbing at the back.
꞉ O2 inhalation- High flow (to maintain saturation 90-95%) .
꞉ Artificial ventilation by AMBU bag.
 b. Prevent hypo or hyperthermia.
c. NPO until baby become stable.
d. IV nutrition .
e. Antibiotics.
f. Start trophic feeding gradually- start 1 ml 4 hourly.
g. Inj. Aminophylline 5mg/kg (0.2ml/ kg) with 10 times dilution in case of apnea of prematurity (premature baby within 7 days) - infuse over 20 minutes as loading dose. Maintenance dose is 0.5ml/kg /day with infusion.

Differential diagnosis of Apnea.

a. Seizure.
b. Periodic breathing.
c. Chocking.

Investigation of Apnea.

TC, DC- to see sepsis.
Hb%- reduces in NEC.
CRP- increased in infection.
RBS- reduced in hypoglycemia.
Serum calcium- reduced in hypocalcaemia.
Serum electrolyte- hypo or hypernatremia.
CXR- to see pneumonia.
USG of brain- to see meningitis, CNS abnormality.
Blood culture.

How aminophylline reduces apnea?

It improves apnea by-
a. Respiratory center stimulation.
b. Antagonize adenosine which causes respiratory center depression. .
c. Improving diaphragmatic contraction.

Periodic breathing.

Pause of breathing more than 3 seconds but less than 20 seconds. It is normal phenomenon in preterm baby.

Name the respiratory centers.

1. Pneumotactic center located at the upper pons.
2. Apneustic center located at the lower pons.
3. Inspiratory and expiratory center are located at medulla.