Clinical Associations of Immature Breathing in Preterm Infants. Part 1: Central Apnea

Abstract

Background

Apnea of prematurity (AOP) is nearly universal among very preterm infants, but neither the apnea burden nor its clinical associations have been systematically studied in a large consecutive cohort.

Methods

We analyzed continuous bedside monitor chest impedance and electrocardiographic waveforms and oxygen saturation data collected on all NICU patients <35 weeks gestation from 2009–2014 (n=1211; >50 infant-years of data). “ABDs”, defined as central apnea ≥10 sec associated with both bradycardia <100 bpm and oxygen desaturation <80%, were identified using a validated automated algorithm.

Results

Number and duration of apnea events decreased with increasing gestational age (GA) and post-menstrual age (PMA). ABDs were more frequent in infants <31 wks GA at birth but were not more frequent in those with severe ROP, BPD or severe IVH after accounting for GA. In the day before diagnosis of late-onset septicemia and necrotizing enterocolitis, ABD events were increased in some infants. Many infants continued to experience short ABD events in the week prior to discharge home.

Conclusions

Frequency of apnea events is a function of GA and PMA in infants born preterm, and increased apnea is associated with acute but not with chronic pathologic conditions.