Apnea
handling to avoid exces-sive fatigue.
Apneais a pause in respirations longer
than 20 seconds with
accompanying bradycardia. Beginning
cyanosis also may be
present. Many preterm infants have
periods of apnea as a re-sult of fatigue or
the immaturity of their respiratory
mecha-nisms. Babies with secondary
stresses, such as infection, hy-
perbilirubinemia, hypoglycemia, or
hypothermia, tend to
have a high incidence of apnea (Thilo &
Rosenberg, 2008).
Gently shaking an infant or flicking the
sole of the foot
often stimulates the baby to breathe
again, almost as if the
child needed to be reminded to maintain
this function. If an
infant does not respond to these simple
measures, resuscita-tion is necessary.
Closely observe all newborns, but
especially preterm ones,
to detect these apneic episodes. Apnea
monitors that record
respiratory movements are invaluable
tools to detect failing
respiration and sound a warning an infant
needs attention.
Infants with frequent or difficult-to-
correct episodes may be
placed on ventilators to provide
respiratory coordination
until they are more mature.
To help prevent episodes of apnea,
maintain a neutral
thermal environment and use gentle
Always suction gently to minimize
nasopharyn-geal irritation, which can
cause bradycardia because of vagal
stimulation. Using indwelling nasogastric
tubes rather than
intermittent ones can also reduce the
amount of vagal stim-ulation. After
feeding, observe an infant carefully
because a
full stomach can put pressure on the
diaphragm and poten-tially compromise
respirations. Careful burping also helps to
reduce this effect. Never take rectal
temperatures in infants
prone to apnea; the resulting vagal
stimulation can reduce
the heart rate (bradycardia), which can
lead to apnea.
Theophylline or caffeine sodium benzoate
may be adminis-tered to stimulate
respirations. The mechanism by which
these drugs reduce the incidence of
apneic episodes is un-clear, but they
appear to increase an infant’s sensitivity
to car-bon dioxide, ensuring better
respiratory function. Infants
who have had an apneic episode severe
enough to require re-suscitation are at a
high risk for sudden infant death syn-
drome (SIDS). Such infants may be
discharged home with a
monitoring device to be used for 2 to 6
months.
Sudden Infant Death Syndrome (SIDS)
SIDS is sudden unexplained death in
infancy. It tends to
occur at a higher-than-usual rate in
infants of adolescent
mothers, infants of closely spaced
pregnancies, and under-weight and
preterm infants. Also prone to SIDS are
infants
with bronchopulmonary dysplasia, twins,
Native American
infants, Alaskan Native infants,
economically disadvantaged
black infants, and infants of narcotic-
dependent mothers.
The peak age of incidence is 2 to 4 months
of age (Barkin &
James, 2007).
Although the cause of SIDS is unknown, in
addition to
prolonged but unexplained apnea, other
possible contribut-ing factors include:
• Viral respiratory or botulism infection
• Pulmonary edema
• Brain stem abnormalities
with laryngospasm. Although many
infants are found with
blood-flecked sputum or vomitus in their
mouths or on the
bedclothes, this seems to occur as the
result of death, not as
its cause. An autopsy often reveals
petechiae in the lungs and
mild inflammation and congestion in the
respiratory tract.
However, these symptoms are not severe
enough to cause
sudden death. It is clear these children do
not suffocate from
bedclothes or choke from overfeeding,
underfeeding, or cry-ing. Since the
American Academy of Pediatrics made its
rec-ommendation to put newborns to
sleep on their back and
with a pacifier, the incidence of SIDS has
declined almost

• Neurotransmitter deficiencies 50% (Damato, 2007). With the

recommendation that in-fants sleep with
• Heart rate abnormalities a fan in their room to keep air moving, the
• Distorted familial breathing patterns incidence is expected to decrease further
• Decreased arousal responses (Coleman-Phox,

• Possible lack of surfactant in alveoli Odouli, & Li, 2008).

• Sleeping in a room without moving air

currents (the in-fant rebreathes expired
carbon dioxide)

Typically, affected infants are well

nourished. Parents re-port that an infant
may have had a slight head cold. After

being put to bed at night or for a nap, the

infant is found

dead a few hours later. Infants who die

this way do not ap-pear to make any
sound as they die, which indicates they
die