Refers to the newborn’s apnea time greater than 20 seconds, accompanied by slow heart rate, heart rate less than 100 beats per minute, or the newborn’s bruising, hypotonia, etc.
Case Statistics of Neonatal Apnea
The incidence of apnea in premature infants is about 20%~30%, and it can reach nearly 50% in very low birth weight infants. Almost all infants with ultra low birth weight have apnea. Most premature infants have intermittent apneas, usually relieved at 38 weeks of gestational age, and sometimes delayed to 42 weeks; ultra-premature infants may be later. In ultra-premature infants with a gestational age of 24 to 28 weeks, especially those with nerve damage, the apnea of preterm infants is often delayed until the gestational age is corrected at full term.
Apnea is pretty dangerous. In order to avoid irreversible damage, babies are usually armed with an ECG monitor. Once it occurs, medical staff can quickly rescue it. However, occasionally there will be situations that are too serious to be rescued, such as late detection, ignoring machine alarms, etc. Some manufacturers on the market will develop apnea self-rescue modules as auxiliary treatment methods. Indeed, the risk of apnea is greatly reduced at certain times.
Why do Newborns Have Apnea？
Human breathing is controlled by the brain’s respiratory center. At the same time, various receptors in the body monitor the changes in the concentration of carbon dioxide and oxygen in the body. When the respiratory center directs the lungs to breathe, it adjusts according to various stimuli in the body. However, the sensory receptors of premature infants are less sensitive to CO2, and the sensitivity gradually increases with the increase of gestational age, and can reach adult level at term.
This is the name of two physiologists who describe this stretch reflex. That is, in order to avoid excessive lung expansion when the human body inhales, the stretch receptors in the lung tissue send signals to the brainstem of the brain to inhibit the inhalation and promote the exhalation transition. The intensity of the Hering-Breuer reflex in preterm infants also increases with the increase of gestational age, until term.
It refers to a 5 to 10 second apnea after 10 to 15 seconds of breathing, which is not accompanied by changes in heart rate or skin color, and most of them can recover on their own. The more immature the newborn, the higher the frequency of periodic breathing. Periodic breathing may also exist in full-term infants and early infancy, which usually occurs within 2 days after birth. So far, no direct connection has been found between periodic breathing and apnea in premature infants.
Apnea of premature infants needs further study, and the possible causes can be roughly divided into central, obstructive, and mixed. Central Apnea refers to the insufficient driving force of the respiratory center to respiration, including insufficient nerve cell function and poor sensitivity to high CO2/low O2 stimulation. Obstructive apnea mainly refers to poor lung function or easy collapse of the airway. Mixed apnea is more difficult to distinguish the cause.
The Management of Apnea in Premature Newborns
Need to strengthen monitoring, stimulate breathing, and supplement with medication
In addition to instrument monitoring and regular inspections by medical staff, mechanical ventilation is also a feasible treatment method. At the same time of monitoring, it is more important to treat the primary disease, because in addition to the immature development of the central nervous system and respiratory system in premature infants, there are often many other diseases at the same time. The common causes of premature infants within 1 to 2 weeks after birth are: hypoxia, cardiopulmonary disease, infection, metabolic disorders such as hypoglycemia or acidosis, nerve damage; common causes after 2 weeks are: gastroesophageal reflux, secondary infection, intracranial hemorrhage, anemia in premature infants, etc.
The Auxiliary Preventive Effect of Neonatal Monitoring on
The neonatal ward is generally monitored for 24 hours. At present, the monitor developed by some monitoring manufacturers has an apnea wake module (apnea wake module). When the blood oxygen of the newborn is lower than 90%, or the electrode cannot detect the breathing, the stimulation module on the sole is triggered to “wake up” the newborn breathing, and there is a corresponding detection interface to analyze whether it is primary apnea, which reduces the risk and provides a diagnostic basis for the clinic.
Of course, the monitoring of equipment is not a panacea and cannot replace people. After all, any equipment has the possibility of failure; and repeated stimulation of the soles of the feet will reduce the sensitivity of neonatal patients, but the asphyxia wake function does solve some delayed processing by nursing staff, even some cases of alarms that are not even noticed, greatly reduce the risk.
In short, the number and frequency of regular inspections by medical staff need to be strengthened. When China’s bed-to-care ratio is still insufficient, it is necessary to rely on the assistance of machines and strengthened inspections to solve certain problems.
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