When a baby is born prematurely, the part of the brain that controls breathing and heart rate may not be fully developed. This may lead to "spells" where breathing stops for 20 seconds or more, then starts again. In some cases, breathing stops for less than 20 seconds and is linked with a drop in heart rate. This is called bradycardia or "brady." The baby may also have changes in skin color (pale or blue) and a drop oxygen level (desaturation or "desat"). This is called apnea of prematurity (AOP). AOP is common among premature babies. The earlier the preemie and the lower the birth weight, the more likely it is that AOP will happen.
During an apnea spell, the baby may become limp, pale, and bluish. The baby's heart rate and oxygen levels may go down. Most of the time, the baby begins breathing on their own again within 20 seconds. But sometimes they need help to start breathing again. Apnea spells may happen once a day. Or they may happen many times a day until the brain becomes more mature. Premature babies born under 35 weeks' gestation need to stay in an intensive care unit because of the risk for apnea.
AOP goes away as a baby matures. It usually goes away within a month or so of the baby's estimated due date. If the baby is in the neonatal intensive care unit (NICU), they are often treated with caffeine. Babies under 28 weeks' gestational age will usually be started on caffeine right away after birth.
The apnea probably will not happen again once your baby stops having apnea spells for at least 5 to 7 days. Or once they stop having the spells for up to 14 days if they have been on a higher caffeine dose.
Preterm babies who have had AOP are not at greater risk for SIDS (sudden infant death syndrome) than other preterm babies.
Home care
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During an episode, you can rub the baby's back or feet or pat the skin. This stimulates the baby's nervous system, which can help restart breathing.
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Never shake your baby in an attempt to restart breathing. This can cause a severe brain injury.
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Feed your baby for a shorter time more often. This can help prevent the baby from getting tired. Ask for more advice about feeding a premature baby. If your baby isn't able to keep up with feeding, call your baby's healthcare provider.
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Always place your baby on their back to sleep and never on their stomach. This is true for naps as well as nighttime sleep. Place your baby on a firm, flat, sleep surface without a slant.
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Don't share a bed with your baby. Place your baby's crib in your room. This is recommended for at least 6 months.
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Don't place your baby on soft surfaces, such as a waterbed, sheepskin, soft pillow, bean bag, soft mattress, or fluffy comforter.
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Don't expose your baby to smoke of any kind. Never smoke or use nicotine products in the home or around the baby. If you smoke, change your clothes before touching your infant. Insist that other smokers follow your example. Make your home and car smoke-free at all times.
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In some cases, infants with AOP are sent home with an apnea monitor. If this is true for your baby, you will be instructed how to use it.
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Parents and caregivers of babies with AOP should be trained in infant CPR before leaving the NICU. But it's unlikely that CPR will ever be needed.
Follow-up care
Follow up with your baby's healthcare provider. Contact the provider if you have any questions or concerns.
When to seek medical advice
Always call your child's healthcare provider right away if you have any questions or concerns. In babies, minor symptoms can get worse very quickly. Your child's healthcare provider may give you different instructions. If so follow their instructions.
Call your baby's healthcare provider right away for any of these:
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Pauses in breathing that last longer or happen more often than usual
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Fever of 100.4°F (38.0°C) or higher, or as directed by the provider
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Baby vomits repeatedly or is not eating well
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Baby is sleeping more than usual or waking for feedings
Call 911
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Your baby has an episode of apnea that does not respond to gentle stimulation or is hard to stop with gentle stimulation
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Your baby is not breathing
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Your baby is blue or pale in color, especially around the mouth and face
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Your baby is having trouble breathing. Signs may include flaring of the nostrils, sucking in the muscles between the ribs or in the belly with each breath, so that the ribs stick out.
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Your baby is lethargic, not responding normally, or unconscious
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If your baby does not start breathing, start CPR and call 911 right away.
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