Apnea of prematurity: challenges and solutions

Figures & data

Table 1 Causes of secondary apnea in preterm infants

Infections	Bacterial sepsis (early-onset, late-onset) Meningitis Local infections (eg, urinary tract infections) Invasive fungal infections Viral infections (eg, respiratory syncytial virus infections)
Respiratory	Congenital malformations of the upper airways (eg, Pierre–Robin sequence) Nasal obstruction Vocal cord paralysis Tracheal occlusion due to excessive cervical flexion Respiratory distress Pneumothorax Hypoxemia Hypercarbia Bronchopulmonary dysplasia
Cardiovascular	Significant patent ductus arteriosus Congenital cyanotic heart disease Congestive heart failure Increased vagal tone Severe hypovolemia Hypotension, hypertension
Neurological	Hypoxic-ischemic encephalopathy Intraventricular hemorrhage Intracranial hemorrhage Conditions causing increased intracranial pressure Congenital myopathies or neuropathies Congenital central hypoventilation syndrome Central nervous system malformations (eg, Arnold–Chiari malformation, Dandy–Walker syndrome) Seizures Pain
Metabolic	Congenital metabolic disorders (eg, hypothyroidism) Acidosis Hypoglycemia Hypocalcemia Hyponatremia, hypernatremia Hypermagnesemia Hypothermia, hyperthermia
Gastrointestinal	Necrotizing enterocolitis Gastroesophageal reflux Abdominal distension (reduces lung volume and increases vagal stimulation)
Hematological	Severe anemia

Table 2 Mechanism of action of proposed interventions for the treatment of apnea of prematurity

Mechanism of action	Treatment
Reduction of work of breathing	Prone, head elevated position nCPAP or nIPPV/nSIPPV
Increased respiratory drive	Oxygen administration Red blood cell transfusion (increases tissue oxygenation) Caffeine Doxapram (not a standard treatment due to side effects)
Increased diaphragm contractility	Caffeine Branched-chain amino acids (there is still a lack of evidence)

Abbreviations: nCPAP, nasal continuous positive airway pressure; nIPPV, nasal intermittent positive pressure ventilation; nSIPPV, nasal flow-synchronized intermittent positive pressure ventilation.