NEONATAL & PEDIATRIC
APNEA
  • Primary & Secondary
  • Definition
  • Central
  • Obstructive
  • Possible Etiologies
  • Physiologi Effects
  • Evaluation & Management
  • Treatments
  • ALTE & SIDS
  • Newborn apnea is catagorized as either primary or secondary apnea
  • Definition
  • cessation of breathing for period sufficient to produce bradycardia & cyanosis
  • lasts 10 - 20 secdonds 

  • categorized as central or obstuctive
  • central- absence of airflow and ventilatory effort
  • apnea of prematurity
  • indirectly proportional to gestational age CO2 response matures 18 extrauterine days
  • may be induced by hyperthermia or dive reflex
  • theophylline primarily caffine citrate usually pg
  • primidone if refractory to theoph
  • arousal response - Non-REM sleep associated with blunted CO2 response
  • Stimulation of airway reflexes-may cause stridor or wheezing in reacive airways. & bradycaredia.
  • Gastroesophageal reflux- 
  • up to 1/3 of preemie apnea is actually GE reflux
  • dysfunction of respiratory centers
  • inadequate development damage by trauma, hypoperfusion or bleeding or drugs.
  • IVH
  • meningitis
  • seizures
  • pharmacologic sedation
  • kernicterus
  • immautrity of respiratory centers
  • tumors
  • dysfunction of the ventilatory  muscles
  • hypoxemia
  • hypercapnea
  • underdevelopment
  • fatigue
  • dysfunction of the preipheral nervous system
  • Guillian Barre
  • Botulism- disrupts neuromuscular junction
  • CNS trauma
  • Werdnig-Hoffman
  • other factors in apnea
  • thermal instability hypo & hyperthermia
  • PDA
  • shock 
  • sepsis
  • anemia
  • metabolic disorders
  • necrotizing enterocoloitis 
  • hypoglycemia,
  • hyper & hyponatremia
  • hypocalcemia

  • suctioning & feeding
  • obstructive- absence of airflow despite ventilatory effort
  • most commonly the tongue
  • anatomic anomalies 
  • choanal atresia
  • Pierre Robin  - & micrognathia
  • larangeal web
  • facial anomalies
  • vocal cord paralysis
  • prematurity of pharangeal muscualture
  • treatment
  • CPAP during sleep periods or IMV

  • anihistamines decongestants steroids cromolyn sodium
  • Apparent Life Threatening Event (ALTE) - Sudden Infant Death Syndrome (SIDS)
  • place infant on back
  • sibling disease is significant
  • occurs 1 month to 1 year of age
  • 60:40 male to female ratio
  • maternal factors include smoking, drug use, poor socioeconomic status, <20yrs. age
  • 5500 deaths per year 
  • winter & night time are factors related to increased disease
  • maternal cocaine use

  • recent illness
      http://msrcol.org/nu/apnea.htm
    updated 4/24/01
    surfneon     neon@surf.to