Apnea in a newborn and infant
What is neonatal apnea, what can cause it, and what are the risks? What are the most common symptoms of apnea in an infant? What does low oxygen saturation mean in a newborn and why does oxygen saturation drop with apnea? What should first aid after respiratory arrest in a newborn and infant look like? Below you will find answers to these and other questions, as well as practical tips for the prevention of apnea.
Apnea is the respiratory arrest in the newborn, which lasts at least 20 seconds or less if it is accompanied by additional symptoms such as a slowed heart rate (less than 100 beats per minute) and / or cyanosis due to decreased oxygenation of the blood, i.e. a decrease in oxygen saturation to 94% and less.
What does apnea mean?
Baby apnea means a condition when a child stops breathing and it may, as a consequence, lead to a threat to his health and life. Neonatal apnea lasting more than 21 seconds can lead to cardiac arrest with serious consequences.
Apnea a low saturation in the newborn
Retention of breathing means that less oxygen reaches the bloodstream, which will result in a decrease in saturation in the newborn. Saturation is the level of arterial blood oxygen saturation - it is measured with a pulse oximeter. Therefore, low saturation in the newborn means a decreased level of blood oxygenation. Every healthy infant is subjected to a saturation test shortly after delivery - between 2 and 24 hours of life. It is a screening test for any undiagnosed heart defects. When are we talking about low saturation in a newborn? The norm for a newborn / infant is 95% -100% - indications below 95% require consultation with a doctor.
How common is apnea?
Apnea affects 1 in 100 live born babies most often in the first 2-3 days of life. In full-term newborns, the frequency of apnea is the lowest (approx. 0,1%) - this indicator increases with the degree of immaturity of the child. The most common cause of apnea in preterm newborns is - related to their immaturity - incomplete development of mechanisms regulating the rhythm of breathing. It is normal for newborns to stop breathing briefly (5-10 seconds).
The causes of apnea
You can distinguish three mechanisms of neonatal respiratory arrest:
- central - associated with abnormal activity of the respiratory center in the brain,
- obstructive - caused by airway obstruction, while maintaining the proper functioning of the respiratory center in the brain,
- mixed - when airway obstruction precedes respiratory arrest in the brain.
Most cases of neonatal apnea are central in origin, less often mixed.
There are many possible causes of sleep apnea in a child - ranging from congenital diseases and complications perinatal, through diseases and infections of the respiratory system, and ending with inadequate sleeping conditions and improper care for the baby.
Apnea in a newborn in the hospital and at home
The most common causes of apnea in a newborn in the hospital include: infections, perinatal hypoxia, congenital metabolic diseases, improper ambient temperature, administering opioid drugs to the mother or high doses of magnesium preparations immediately before delivery, treatment of the newborn with drugs limiting the respiratory center function in the brain, intracranial bleeding, necrotizing enterocolitis.
If a toddler is suffering from apnea at home, the possible causes should be mentioned: too soft bedding, sleeping on the stomach, congenital tendency to shallow breathing, apnea and breathing problems, prematurity, especially when the child's respiratory system has not had time to shape properly, chills /overheating of the baby, diseases and infections of the respiratory system, sleeping with other people (parents, siblings), smoking in the presence of a child, too many pillows, blankets in the bed.
Apnea: in sleep and when crying
It's good to know that apnea occurs not only in sleep. Newborn apnea may occur during heavy crying. The baby cries so hard that it starts to run out of breath, but usually after a while it starts crying again and "regains its breath". It is very dangerous to have apnea during sleep or when the baby is quietly lying in the crib. Parents may not notice the lack of breath, thinking that the child is sleeping or lying down well.
Symptoms or How to Identify Apnea
Here is a list of symptoms that indicate a newborn or infant may be suffering from apnea:
- No chest movement (when inhaling, the chest rises, and when exhaling, it lowers).
- Slow heart rate (bradycardia) and a decrease in hemoglobin oxygenation (desaturation, or a decrease in saturation), a change in the color of the skin and mucous membranes - first pale, gray, and then blue.
- Total silence - a child who has apnea does not make any sounds, i.e. does not cough, cough or cry (when the child is not breathing, but tries to grunt and make sounds, it may turn out that he choked on something).
- The frown on the child's facewhich resembles shock, surprise - the infant does not know what is happening and is surprised that it is not breathing.
- Cyanosis - when a child is out of breath for a long time, first his lips begin to turn blue, and then his face.
In a situation where we notice such symptoms, the child should be given first aid immediately.
Newborn apnea: first aid
What should first aid look like if a newborn has apnea? It is necessary to carry out the following steps:
- Blow on the baby's nose and upper lip. This is to help the air reach the baby's respiratory system and cause him to breathe normally. This is the fastest way to save a child, which often turns out to be effective, e.g. with intense crying, choking, so-called "Drifting".
- Tickling in the foot or with a gentle pinch. Stimulating your baby will make him focus on something else and start breathing.
- Tilt the baby upside down and pat her on the back.
If, after applying the above methods, you do not notice the child's reaction, you should call an ambulance (999 or 112) and proceed with resuscitation.
Expert advises
First aid, i.e. cardiopulmonary resuscitation, is artificial respiration and heart massage, which is performed in the case of lack of breathing and lack of pulse in a child (and also in an adult - only in a different way). Using artificial respiration, we pump the oxygen necessary for life into the lungs of the baby, and heart massage - i.e. skillful pressure on the chest - pumps oxygenated blood to the most important organs, preventing them from damage or even death of the child. Immediate resuscitation of a newborn / infant can save life and prevent serious injuries to the baby's body!
First aid after choking or choking
- We check if the airways are open. To do this, we put the baby away from the bottle / breast, tilt it to the side and observe the oral cavity. When you notice a foreign body (toy, bottle cap, etc.), use your smallest finger to pull it out of the baby's mouth. If it helps, the baby starts crying.
- In a situation when the child is not crying and still has breathing problems, grab his chin, put three fingers on the toddler's shoulder, turn him upside down - so that he lies in the prone position on our knees, and his head is like lowest. Place the forearm on the thigh, and with the other hand, folded into a boat, strike firmly and vigorously up to 5 times between the shoulder blades. If this works, the little one starts crying.
- If the baby is not crying, change the position - grabbing the back of his head with his thumb and forefinger and holding three fingers on his shoulder, we turn the baby to the supine position, with the head still lower. Then we place two fingers on the toddler's chest and press 5 times.
- This is where you should immediately call an ambulance by calling 999 or 112. If the parent is alone, he or she first calls and then continues the heart massage or follows the instructions of the dispatcher - until the child's condition improves or an ambulance arrives.
- If the condition worsens and the toddler stops breathing, place him on his back on a hard, safe surface (table, floor), cover the child's nose and mouth with your mouth, and then breathe 5 times. We continue these steps in sequence: 1 inhale and 3 chest compressions until the baby improves or the ambulance arrives.
First aid with loss of consciousness and lack of breath
Method "I can see, feel, hear ”pwe check if the baby is breathing - put the cheek to the baby's mouth for 10 seconds to observe the breathing movements of the chest, feel the breath on the cheek and listen to the sounds of breathing. If necessary, we open the airways as described above. When we have noticed at least 5 breaths and the child is unconscious, we call the ambulance service, place the child in a side position and watch, ensuring him thermal comfort.
If the child is not breathing, make 5 breaths as above. When inhaling, we should see that the toddler's chest rises upwards. We continue CPR until the baby is corrected or an ambulance arrives.
Newborn apnea: prevention
In order to prevent apnea in newborns and infants, exposure of the child to factors that may provoke or worsen their occurrence should be limited. For children at risk of developing apnea, breathing monitors are recommended. It is also recommended that infants (under the age of 1) always sleep on their backs. The supine position is safe and does not increase the risk of aspiration, also in children with gastroesophageal reflux disease. Lying on the stomach is considered beneficial, but the baby should then be awake and under the supervision of the caregiver (except in cases of disease disorders in which the position on the stomach is safe for the baby). Sleeping on your side is considered unsafe and not recommended for toddlers. When the infant begins to turn on its own, it is recommended to continue to sleep on its back, but allow it to continue sleeping in a position that the child will assume itself.
Practical tips, or what not to do?
To minimize the risk of a newborn or infant suffering from apnea, you should follow a few simple rules:
- Babies should sleep in a separate cot ? on a new, hard mattress that does not change shape under the weight of the child's head, with a fitted sheet.
- Is preferred using sleeping bags or covers ? instead of ordinary blankets or duvets, due to the lower risk of the child covering his / her head.
- It should be avoid overheating the baby ? should wear at most one more layer of clothing than an adult.
- There should be no pillows in the cot, other bedding elements or other soft objects.
- Do not use car seats or other equipment in which the baby sits as a place for regular sleep. If a child falls asleep in the car seat, it should be moved to the crib as soon as possible and safe.
- The pacifier should not be attached to the baby's clothes nor hang it around his neck.
Unfortunately, it is impossible to predict everything, so parents are primarily advised to be vigilant and watch their children.
Źródła:
Standards of medical care for a newborn in Poland 2020;
Rutkowska M., Adamska E., Reśko-Zahara M .: Resuscitation of the newborn. Bielsko-Biała, 2016, pub. 2;
Kwinta P .: Apnea in newborns, Medycyna Praktyczna (2016);
SIDS Prevention - AAP Recommendations, Medical Standards (2016).
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