Apnoea and Bradycardia of Prematurity

Bradycardia is a slowing of the heart rate. In premature babies this would be less than 100 beats per minute. It is often followed by a period of apnoea.
As your baby gets older (nearer the date they should have been born) the heart rate will slow and may be less than 100 beats per minute when they are sleeping.

No, not always. Apnea and bradycardia can be caused by (or increased in frequency by) infection, low blood sugar, temperature instability, hypoxia (insufficient oxygen), seizure or mechanical problems with breathing, ie secretions blocking the airway.

Premature babies have an immature respiratory centre in the brain, so have periods of shallow breathing or pauses in breathing. Apneas are more common when babies are sleeping. As a baby gets older, his or her breathing will become more regular. Usually, apnoea of prematurity improves markedly or goes away by the time the baby reaches 34 or 35 weeks gestation, although this can vary.

Your baby may need one or more of these:

• medication that stimulates breathing, such as caffeine stimulation – gentle stroking or tickling of the feet
• continuous positive airway pressure (CPAP) or delivery of high flow oxygen – called vapotherm. Air and oxygen are delivered under pressure via small tubes in the baby’s nose
• mechanical ventilation (breathing machine). If your baby’s apnoea is severe, he or she may need help with breathing.

Your baby’s heart rate and breathing may be monitored continuously if:

• he or she is on caffeine medication
• he or she is less than 35 weeks’ gestation.

Cardiac (heart) monitoring will stop when caffeine has been discontinued for 48 hours and no further bradycardia has been seen.

Respiration monitoring with an apnoea monitor will continue until 34-35 weeks’ gestation. If there are no concerns with your baby’s breathing, this will stop too.

• A nurse will observe your baby to see if he or she is breathing and if there is any change in colour or if the heart rate is changing.
• The nurse may stimulate your baby to remind him or her to breathe
• If there is a change in colour, the nurse will assess your baby and may give additional oxygen
• If your baby does not breathe, the nurse may give him or her a few breaths using a face mask called a neopuff.

Yes. Your baby will not be discharged if he or she still has any apnoea and bradycardia. He or she needs to be off all medication and monitoring. Some babies are candidates for home apnoea monitoring:

• babies still requiring added oxygen on discharge
• where the consultant feels it is a good idea for your baby, such as previous medical history.

Apnea of prematurity is a result of immaturity. Once a baby grows it will go away, usually between 34-35 weeks’ gestation but this can vary.

No, they are two entirely different issues.

Many babies who die from SIDS have a normal newborn period. Babies who have needed neonatal intensive care for any reason are at a slightly higher risk of SIDS than any other baby.

Research carried out by the Lullaby Trust has shown that apnoea of prematurity alone does not increase their risk.

If you have any further questions or concerns, please ask a member of staff.

To find out how to give us feedback on your visit or healthcare experience, please visit www.esneft.nhs.uk and search for ‘PALS’ or ‘Your views matter’, or speak to a member of staff on the ward or department you are in.