Apnea in newborns: main causes and methods of control

• Pulmonary breathing in a child begins immediately after birth, when his lungs expand with his first breath.
• Before this, the baby receives oxygen through the placenta.
• Therefore, in many infants, normal breathing is not immediately restored, especially for premature babies.
• Babies under one year of age often experience nocturnal breathing stops, or apnea.

If they are short-lived and repeated infrequently, then there is no need to worry. As the child gets older, breathing will improve. Pathological apnea in newborns requires urgent treatment.

About the disease

Infants have several types of breathing:

1. Regular . The baby breathes evenly with equal intervals between inhalation and exhalation.
2. Irregular . It occurs in premature infants and is characterized by unequal intervals between breaths.
3. Periodic . Periods of hypo- and hyperventilation alternate, and a 3-second breath hold occurs.
4. Apnea . This condition is pathological and is characterized by a long period without breathing (more than 15 seconds). At the same time, a heart rhythm disturbance occurs. If breathing is restored quickly, this is considered normal and does not require treatment.

However, a long period of inactivity is very dangerous for the child. Oxygen does not reach the brain, hypoxia develops, which causes developmental delays and various nervous pathologies.

The most dangerous complication is death. Parents do not always notice the violation, since it happens in a dream.

The following types of apnea are distinguished:

1. Central . Triggered by disturbances in the respiratory center of the brain. The transmission of nerve impulses is reduced, so the respiratory muscles do not receive the necessary signal.
2. Obstructive . Develops as a result of obstructive processes in the respiratory tract. That is, air physically cannot pass through the nasal and oropharynx.
3. Mixed . Combines signs of central and obstructive.

Reasons for a child under one year old

Apnea most often occurs in premature infants, especially those born before 34 weeks and weighing less than 2.4 kg. Their breathing control center is undeveloped, so signals to the brain are poorly received.

With proper care for such a child, after 1.5-2 months everything returns to normal.

The causes of the central type of disease are:

1. Premature birth.
2. Birth injuries.
3. Fetal hypoxia.
4. Reduced blood glucose levels.
5. Impaired alveolar ventilation.
6. Epilepsy.
7. Anemia.
8. Blood poisoning.
9. Lung dysplasia.
10. Pathological jaundice.
11. Metabolic disease.
12. Cardiac pathologies.
13. A woman taking medications during pregnancy.

Often it is impossible to identify the cause of the disorder, so a diagnosis of “idiopathic apnea” is made.

In children aged several months and older than one year, the obstructive type of the disease usually occurs.

The reasons are:

1. Congenital anomalies of the structure of the oropharynx (cleft lip, macroglossia, Robin's syndrome).
2. Spasms of the muscles of the larynx.
3. Allergy.
4. Slow growth of cartilage tissue, which leaves the palate too soft (achondroplasia).
5. Adenoids, enlarged tonsils.
6. Overweight.

Mixed reasons:

1. Heart diseases.
2. Hypocalcemia, hypoglycemia.
3. Mother's drug use.

Symptoms in infants

The clinical picture of the disease in newborns is somewhat different from adult manifestations. If an adult experiences snoring and noisy breathing, then in a baby this happens quietly and unnoticeably.

If no one is nearby during a prolonged attack, it can be fatal.

Signs of apnea in children are:

1. Restless sleep, frequent waking up, coughing.
2. Breathing through the mouth in sleep.
3. Freezing of the chest movement on exhalation.
4. Profuse sweating (indicates disturbances in the functioning of the nervous system).
5. Bed-wetting.
6. Non-standard position of the child's body in sleep. This is compensation for the lack of oxygen.
7. Decreased daily activity of the child.

You can recognize a serious attack of apnea in a baby by the following signs:

• blue lips, nose;
• decreased heart rate (less than 60 beats);
• cessation of chest movement.

Illness in premature babies

In children born prematurely, apnea occurs in 8 out of 10 cases. This is due to the underdevelopment of the parts of the brain responsible for breathing. The connections between neurons have not yet been formed, so the impulse does not enter the brain.

It can also be caused by insufficiently opened lungs. For example, a baby may only have one lung open.

They provoke respiratory disorders and other developmental abnormalities of the child. If the disorders are associated with underdevelopment of the nervous system, then this can be corrected.

Doctors prescribe neurological treatment, after which the baby catches up with full-term babies in development, the symptoms of breath holding disappear after 1.5-2 months.

However, if left untreated, the consequences can be disastrous. If the brain is left without oxygen for more than 20 seconds, hypoxia develops. It leads to the death of nerve cells.

Complications of neonatal apnea:

1. Developmental delay.
2. Neurological problems.
3. Epilepsy.
4. Attention deficit hyperactivity disorder.
5. Atrial fibrillation. Lack of oxygen affects the functioning of the heart, disrupting its nutrition.
6. Problems with blood pressure. Due to oxygen starvation, compensation mechanisms are activated, blood circulation increases, and because of this, pressure rises.

In addition, constant lack of sleep causes a child to be nervous, capricious, have poor appetite and be underweight. The most serious consequence of apnea is death.

To prevent complications, premature babies are placed in incubators, where conditions similar to those in the womb are created. They are monitored around the clock; sensors record episodes of apnea.

If the baby cannot breathe on his own, then a ventilator is connected. Oxygen therapy and drug treatment are also prescribed. The choice of treatment depends on the child’s condition and the degree of impairment.

Diagnostics

Initially, the diagnosis is made based on parental complaints. The doctor recommends observing the baby while he sleeps and using a stopwatch to record the time and frequency of breathing stops.

The most informative diagnostic method is polysomnography . Special sensors are placed on the baby’s head and chest, which transmit the following information to the computer about:

1. The work of the heart.
2. Intensities of electrical impulses.
3. Pulse and heart rate data.
4. The strength of the respiratory flows.
5. Intensity of chest movements.
6. Motor activity during sleep.

This study is carried out by a specialist in a hospital setting.

Emergency care for a night attack

Holding your breath for a long time can lead to death, so parents should know how to provide first aid during an attack.

An ambulance should be called in the following conditions:

1. The baby's face and mouth turned blue.
2. The pulse dropped below 60 beats.
3. The chest does not move or moves very rarely.
4. The baby's arms and legs hang down involuntarily.

Providing assistance is as follows:

1. Tactile irritation. You can run your fingers along the spine, rub the earlobe, rub the baby’s arms and legs. If this does not help, artificial respiration is necessary.



2. Place the child on a horizontal surface, check to see if the tongue is stuck and there is no vomit in the mouth.
3. Raise your head and tilt it back a little.
4. Cover the baby's nose and mouth with your mouth and take 2 breaths each for 2 seconds.
5. Repeat until the chest begins to move.
6. Once your chest begins to move, feel for a pulse in your arm or neck, then take a few more breaths.
7. If there is no pulse, indirect cardiac massage is necessary. To do this, place two fingers in the middle of the chest at the level of the heart and apply frequent pressure. They alternate with breaths.

Resuscitation measures continue until the ambulance arrives, then the child must be taken to the intensive care unit.

Under no circumstances should you feed the child or try to give him water, as water may get into the lungs and the child will choke. It is also prohibited to give any medications.

When it passes, possible consequences

Apnea in newborns and children under one year of age is rare. This is usually typical for premature babies or those who have suffered a birth injury.

Mild cases resolve on their own as the child grows older. In case of serious deviations, medical attention is required.

Holding your breath at night is very dangerous for a baby, as it can lead to serious complications, even death. Therefore, it is important for parents to know the symptoms of an attack and first aid methods.

1. Prevention of the disease in infants consists of proper management of pregnancy and childbirth, and the mother’s attentive attitude to her health.
2. Apnea in a newborn baby:

Source: https://nerv.guru/zabolevaniya/rasstrojstva-sna/apnoe/u-novorozhdennyx.html

Apnea in newborns: causes of attack, complications, assistance

Apnea in newborns is a delay in breathing that occurs for various reasons. In the vast majority of cases, apnea occurs in premature newborns. This is explained by the underdevelopment of the baby’s brain centers responsible for the breathing process.

Features of breathing in newborns

Newborns often experience breathing problems: increased inhalations and exhalations alternate with slower ones. If the interruption of the respiratory process continues for more than 10 seconds, you should think about the development of apnea in the baby, a pathology that is rare, but can lead to serious consequences.

During the first months of a child’s life, anatomical narrowness of the nasal passages is observed, and difficulty breathing through the nose is noted. When infected with viruses and bacteria, swelling of the mucous membrane develops, associated with further discharge of secretions. A newborn baby cannot breathe through his mouth, which results in sleep disturbances and makes feeding difficult.

Medicine divides the breathing of newborns into 4 types:

• Regular. Uniform breathing with the same period between breaths.
• Irregular. The type is typical for premature babies. The interval between breaths is not the same.
• Periodic. It is cyclical. Hypoventilation is replaced by the opposite process. Breath holding is observed for up to 3 seconds.

It is important to know! Apnea is a pathological condition characterized by cessation of breathing. The attacks last from 15 seconds. The pause may be short-lived, but bradycardia is observed. With rapid recovery, the apneic effect is considered normal.

Apnea in infants

According to the International Classification of Diseases (ICD), apnea refers to respiratory and cardiovascular disorders.

Explanation of the term

Apnea can be defined as a prolonged pause in the breathing process in which the breathing reflex is suppressed. The pathology has another name: an apneic episode. Although not an independent disease, apnea accompanies various disorders in the body.

With a mild form of the pathology, the baby automatically restores breathing. With severe apnea, a clinical picture is observed: a slow heartbeat, color changes in the skin. Due to lack of oxygen, nails become bluish in color. The same reason leads to brain starvation. Without adequate help, the syndrome does not go away on its own, and death can occur.

Development mechanism

In premature newborns, attacks of apneic episode syndrome occur from the first day of birth for no apparent reason during the REM sleep phase. There is a decrease in the tone of the intercostal muscles, a decrease in lung volume, and hypoxia develops, which has serious consequences.

There are 3 forms of apnea:

1. Central.
2. Obstructive.
3. Mixed.

Central apnea

It is caused by the cessation of transmission of brain impulses to the respiratory muscles forced to remain inactive, as a result of which the infant stops breathing.

Obstructive apnometric gap

The brain signal is transmitted to the respiratory muscles, the air flow is interrupted due to the narrowing of the lumen of the respiratory system.

Mixed apnea

This type of pathology combines the 2 previous types of disorders. The onset of an apneic episode is similar to the central one, further development takes place according to the obstructive type.

Immediate causes of the syndrome and risk factors

The causes of apnea in newborns are not well understood. The main prerequisites for the syndrome are considered to be:

1. Pathologies of the respiratory system.
2. Complications during childbirth.
3. Hereditary predisposition.
4. Allergies to medications.
5. Prematurity.

Risk factors

For central apnea:

1. Birth weight less than 2 kg.
2. Immaturity of the central nervous system.
3. Anemia.
4. Gastroesophageal reflux.
5. Intracranial and spinal trauma.
6. Cerebral palsy.
7. Down syndrome.
8. Bronchopulmonary dysplasia.

For obstructive apnea syndrome:

1. Frequent regurgitation.
2. Respiratory infections,
3. Heart rhythm disturbance
4. ENT diseases,
5. Swelling of the laryngeal mucosa,
6. Decreased muscle tone
7. Malocclusion,
8. Overweight.

The most common cause of apnea, according to renowned doctors, is smoking and drinking alcohol by the mother during pregnancy and breastfeeding.

Symptoms depending on the severity of apnea

Knowing the symptoms of a disorder, you can predict its occurrence. A characteristic sign of apneic episode syndrome is convulsive swallowing of saliva, requiring emergency assistance.

Holding a newborn's breath is accompanied by symptoms:

1. Abnormal breathing rhythm.
2. Rare pulse.
3. Stop breathing for 10 seconds.
4. Bluishness in the facial area.
5. Cramps.
6. Breathing through the mouth.
7. Urinary incontinence.
8. The appearance of prickly heat.
9. Strong drooping of the chest when exhaling, long recovery period.
10. Unusual sleeping position.

When there is a clear danger to life, apnea is characterized by the following symptoms:

• Cyanosis of the skin.
• Relaxation of muscles.
• Shock.
• Vomiting.

To avoid death, resuscitation measures are immediately carried out to restore cardiopulmonary functions.

Complication of frequent attacks

The apneic episode syndrome is complicated depending on the age of the baby, the frequency of attacks, and the duration of their course.

The amount of oxygen entering the lungs decreases. This leads to an increase in the acidity of the blood and tissues. Small arterial branches contract, and an increase in blood pressure is observed in the lungs.

Attention! Severe apnea that continues over a long period of time can cause brain damage and subsequently lead to cerebral palsy. If a newborn has an undetected severe apneic episode while sleeping at night, it can be fatal.

Diagnosis of pathology

When diagnosing, a thoroughly compiled pathological history is of great importance, recording:

• pregnancy progress indicators;
• health status of mother and father;
• presence of bad habits in parents;
• the presence of apnea syndrome in close relatives.

After interviewing the mother for the presence of clinical symptoms confirming apneic episode syndrome and examining the child, the doctor may prescribe one or more of the following research methods:

1. Ultrasound of the heart.
2. X-ray.
3. Computed tomography.
4. Magnetic resonance imaging.
5. Encephalogram of the brain.
6. Electrocardiogram of the heart.

Emergency assistance for a child

In a hospital setting, there is every opportunity to relieve an attack of a life-threatening syndrome; parents need to know how to help their child.

At home

In case of detection of apnea attacks in newborns, it is recommended to perform the following actions:

• Take the child in your arms and run your fingers along the spine.
• While holding your breath, massage your chest.
• Shake to wake up baby.
• Sprinkle your face with cool water.

Artificial respiration for apneic episode syndrome in premature infants is mandatory:

1. The baby is placed on the table with his head thrown back.
2. Opening the child’s mouth, wrap your lips around the mouth and nose.
3. Take careful breaths.

If breathing is not restored after two attempts, you need to make 8 more attempts and begin emergency closed cardiac massage. The procedure makes it possible to expand the airways and fill the lungs with air. After breathing normalizes, the baby’s arms and legs are rubbed.

Advice! Only a doctor has the right to carry out full treatment; the mother should definitely agree to hospitalization.

In the hospital

The pediatrician acts according to the following algorithm:

• If there is a threat of aspiration, when the child falls face down, the baby should be placed on his side with his head thrown back.
• Using a medical spatula, open the baby's mouth.
• Mucus accumulations are removed from the nose and mouth. For this purpose, an electric suction is used.

Asphyxia manifests itself in a certain sequence. Within 3 minutes there is an increase in the frequency and depth of breathing, then signs of primary apnea appear. When asphyxia continues, attacks of suffocation will lead to a secondary apneic episode.

If necessary, perform artificial respiration. To restore the process, the child is supplied with humidified oxygen. In case of severe condition, the baby is connected to hardware respiratory support.

Prevention of sleep apnea in infants

To prevent an apnea attack, you should follow the recommendations of your doctors. In particular, the advice of the famous TV presenter and experienced pediatrician, Dr. Komarovsky, will be interesting and useful:

• A premature baby should sleep on its side.
• Avoid overheating your baby to avoid increasing the risk of holding your breath.
• Ventilation of the room where the baby is located must be mandatory.
• An optimal level of humidity should be ensured in the child's room.
• Spend as much time as possible walking with your baby in the fresh air.
• Before going to bed, it is advisable to rinse your baby's nose with a weak saline solution.
• When sleeping, the child should wear loose clothing made from natural fabrics.
• Choose an elastic mattress for your baby; the baby does not need a pillow.

Apneic episode syndrome is especially dangerous for newborns and infants. Before becoming pregnant and giving birth, the mother needs to get rid of bad habits that are fraught with dire consequences for the unborn child.

You should be attentive to your baby: treat it in time, monitor night sleep, analyze the condition of the baby. You need to remember the symptoms so you can report them to your pediatrician. This will be a significant help in improving the child’s health and may even save his life.

Source: https://znatoksna.ru/rasstrojstvo-dyhanija/harakternost/apnoeh-u-novorozhdennyh.html

Why does a baby hold his breath during sleep - baby apnea syndrome

Neonatal apnea syndrome is a sleep disorder characterized by periodic breath holds of 10 to 20 seconds or more. During one episode of a baby's sleep, up to 60 stops in respiratory function can be recorded using special polysomnographic equipment.

With a long and careful study, it is discovered that almost every premature baby suffers from episodic apnea. At the same time, children whose gestational age exceeds 36 weeks suffer from this disorder much less often and tolerate it better.

Apnea syndrome is a serious disease: during night attacks, the ability to provide first aid to a child can save his life.

Infant apnea: features of the condition

Apnea syndrome in infants is often confused with normal breath-holding. With periodic breathing, pauses between inhalation and exhalation are 2–10 seconds, and there are no symptoms of pathology: blue discoloration of the nasolabial triangle and nails, wheezing.

If, after holding your breath during sleep, the baby continues to breathe steadily and calmly, there is no reason for concern.

If delays are repeated frequently, lasting up to 20-25 seconds, accompanied by other symptoms of apnea syndrome, you should consult a doctor.

It is worth differentiating the syndrome of central and obstructive apnea:

• in the first case, short-term breath holdings are not accompanied by any effort on the part of the child: he simply periodically stops breathing. The syndrome may be associated with pathologies of the lungs, heart, and respiratory center of the central nervous system;
• in the second case, breathing becomes difficult as a result of blockage (obstruction) of the airways.

Primary and secondary apnea

In neonatology (a branch of medicine that studies the growth and development of infants and children in the first months of life) and obstetric practice, the concept of primary apnea refers to the initial difficulty of pulmonary ventilation due to perinatal hypoxia.

The condition is accompanied by cessation of respiratory movements, arterial hypertension and bradycardia. With primary apnea, the newborn convulsively holds his breath: the inspiratory muscles contract to the maximum, exhalation is passive, this condition is called “gasping breathing.”

After assisted pulmonary ventilation, the baby's breathing is quickly restored, without causing any complications in the future.

Secondary apnea is the cessation of respiratory movements after gasping breathing and primary resuscitation. This condition is characterized by weakening muscle tone and a drop in blood pressure. In this case, the baby’s normal functioning will be restored slowly, with possible complications in the future.

Primary apnea can also mean a disorder of respiratory function detected in a newborn in the first weeks of life: it is common in children who are born prematurely or have suffered birth injuries. In this case, secondary apnea will be called short-term breathing stops at night in infants, which appear at 3-6 months and are associated with various developmental pathologies and diseases.

Diagnosis of the disease

If a newborn child experiences constant breathing delays during sleep, you need to consult a doctor: a pediatrician, otolaryngologist, pediatric neurologist or pulmonologist.

If this condition is detected in premature babies, consultation with a neonatologist is necessary.

Diagnosis of the disease in newborns

The main method for diagnosing apnea in infants is polysomnography: with its help, the presence of the syndrome is confirmed: respiratory arrest is visually observed, the number and frequency of delays is recorded.

During the study, the child is placed in the most comfortable conditions. During sleep, sensors and electrodes connected to certain areas of the body record changes in the parameters of organ activity.

If a disturbance in the functioning of the cardiovascular system is suspected, the doctor will select other methods: ultrasound examination of the heart and blood vessels of the brain, ECG of the heart.

Other diagnostic measures:

• radiography (to exclude pneumonia);
• CT and MRI;
• encephalogram of the brain.

Diagnosis of pathology in premature babies

An episodic lack of breathing lasting 20 seconds or more, accompanied by blue or pale skin and a slow pulse, allows us to make an initial conclusion about sleep apnea syndrome in a premature baby.

Most often, children of small gestational age suffer from central apnea. The main diagnostic method is neurosonography (ultrasound of the brain): its results reveal pathological changes in the morphology of the organ (particular attention is paid to the brain stem: it is where the respiratory center is located), brain processes and their dynamics are analyzed.

If there are deviations, a lumbar puncture is performed: it makes it possible to detect intraventricular hemorrhages and foci of inflammation.

Symptoms of infant apnea

The main symptom of apnea is respiratory failure: a stop can be detected by the cessation of movements of the diaphragm. This way you can differentiate between central and obstructive apnea: in the second case, the baby continues to make breathing movements.

In addition to respiratory arrest, apnea can be identified by the following symptoms:

1. Pale or bluish discoloration of the skin, blue discoloration in the mouth and folds of the nose (associated with oxygen deficiency).
2. Snoring is the main sign indicating the obstructive genesis of apnea.
3. Restless sleep.
4. Enuresis is one of the signs of a dysfunction of the central nervous system; it is difficult to detect in infants for obvious reasons.
5. Hyperhidrosis.
6. Convulsive gasping for air, breathing through the mouth during sleep and while awake.
7. Shortness of breath after normal breathing is restored.

Due to constant lack of sleep, the child’s daytime behavior changes, he becomes more whiny and irritable.

Seizures can occur in newborns in the first weeks of life and in children older than 6 months.

Causes and consequences of infant apnea

In newborns of insufficient gestational age, apnea syndrome appears especially often and is associated with immaturity of the central and peripheral nervous systems.

Causes of periodic respiratory arrests:

1. Intraventricular hemorrhages.
2. Congenital pathologies of the cardiovascular system.
3. Pathology is often associated with maternal diseases: intrauterine infections affect the baby’s brain structures.
4. Immaturity of the laryngeal muscles.
5. Craniofacial anomalies, laryngeal pathologies.
6. Obstruction of the upper respiratory tract associated with insufficient development of the muscular corset.

Acquired causes of infant apnea:

• meningitis;
• adenoids;
• enlarged tonsils;
• infectious diseases;
• epilepsy;
• asphyxia;
• insufficient oxygen supply to the blood and associated oxygen starvation;
• gastroesophageal reflux.

Frequent episodes of breath-holding during sleep are potentially dangerous to the health and life of the baby. If the duration of breathing pauses exceeds 20 seconds, neurons begin to die. Prolonged hypoxia causes irreversible pathologies of the heart and blood vessels, bronchi, and lungs.

In premature infants, apnea disappears after the onset of morphological and functional maturity of the central nervous system and usually does not cause complications.

Frequent apnea in children aged 6 months can cause a variety of neurological disorders:

1. Inability to concentrate.
2. Hyperactivity.
3. Difficulties of socialization.
4. Memory impairment.

First aid and seizure prevention

Apnea attacks can go unnoticed even with constant visual monitoring of a sleeping baby. In case of severe asphyxia - blueness of the skin around the mouth and folds of the nose, prolonged absence of respiratory movements, slow pulse (in a child under one year old, the pulse is easier to feel on the brachial artery or fontanel), you need to provide the baby with first aid:

1. You need to take the newborn in your arms and try to bring him to his senses: any tactile irritation will help, be it patting and stroking the back from bottom to top, rubbing arms, legs, earlobes, tickling and clapping on the feet.
2. You can sprinkle the baby with cool water.
3. To make breathing easier, the baby needs to be turned onto his stomach with his head turned to the side (premature babies are often placed in this way in incubators).

If a few seconds after the start of manipulation the child does not begin to breathe, artificial respiration will be required.

The baby is placed with his back on a flat, hard surface, a folded towel is placed under the shoulder blades, and the head is tilted back slightly.

Holding your head with your hands, you need to inhale air in small portions (a newborn has a small lung capacity) into the mouth and nose simultaneously. If after 5–8 breaths breathing is not restored, indirect cardiac massage is performed.

When a child is hospitalized with suspected apnea, a set of diagnostic procedures is performed, after which measures are taken to alleviate the baby’s condition. Drug treatment of the disease is aimed at eliminating the causes of the syndrome.

Premature babies suffering from this disease are placed in a special incubator.

If attacks recur, the following measures are taken: the temperature inside the incubator decreases, the air flow into the incubator increases, and the baby is connected to the artificial pulmonary ventilation system.

Holding your breath during sleep can be prevented by following these rules:

1. The bedroom should be regularly ventilated and humidified. Before going to bed, the child should not be overheated.
2. For a baby, you need to choose the right bedding: an elastic, hard mattress, hypoallergenic filling of pillows and blankets (feather products are not suitable).
3. In the presence of a newborn, you should not spray aerosol household chemicals and cosmetics, use perfume, or distribute cigarette smoke.

At the first suspicion of apnea, it is worth moving the child’s bed to the parents’ bedroom: this will allow continuous monitoring of his condition.

Source: https://infson.ru/narusheniya-sna/apnoeh/u-novorozhdennih

Apnea in newborns: signs, causes, treatment

It happens that newborn children breathe with significant deviations from the norm. The rhythm of breathing becomes confused, or, even worse, interrupted, may slow down or become more frequent.

In medicine, it is generally accepted that apnea develops in the event of 10-second or more interruptions in respiratory function. And although treatment for apnea in infants is rarely required - the disease itself simply does not occur so often, the consequences of such a disease are very serious.

Don't be afraid of periodic breathing. This is not a disease and this condition is not classified as apnea. Newborns up to six months breathe faster than usual.

In this case, short 2- and 5-minute stops may occur, and then breathing resumes. In pediatrics, this is classified as physiological respiratory arrest. It is also called periodic breathing.

It is not dangerous if the pauses do not exceed the norm and do not become constant, and breathing resumes on its own. 

Signs of sleep apnea in babies

The general signs of apnea in newborns practically coincide with the clinical picture of this disease in adults. But the list is much longer.

The most common symptoms of childhood apnea include:

• Prolonged absence of normal breathing movements, when the baby's chest stops rising and falling;
• The baby's pulse becomes very rare;
• The skin becomes bluish, especially on the lips and face;
• A newborn breathes through his mouth, because a sufficient amount of oxygen does not enter through the nose;
• The baby often and difficultly swallows saliva, which indicates the narrowness of the lumen of the larynx;
• While breathing is held, urinary incontinence occurs;
• The baby develops heat rash;

When the baby tries to establish the breathing process, he tries to roll over and raise his head.

Causes

Newborns suffer from apnea due to many factors. More often this happens due to the lack of a signal in the brain, which sends a message to inhale. This is exactly the problem that occurs in infants with Down syndrome or developmental defects.

• It has long been proven that children born prematurely do not have fully formed lungs, so they are susceptible to apnea to a large extent. 
• In addition, the problem may appear against the background of hereditary or congenital diseases, birth injuries or brain hematoma. Infectious diseases of the nasopharynx also have a negative impact.
• Causes include seizures, aspiration and whooping cough, as well as medications, maternal smoking and allergic reactions.
• Babies born before 34 weeks weighing less than 2.4 kilograms are especially susceptible to apnea.

How to treat apnea in newborns?

What should parents do if their newborn holds their breath for a long time?

• Take the child in your arms and actively and repeatedly move your hand down along the spine.
• Rub your child's legs, ears, chest and arms.
• If there is no reaction, splash slightly cool water on your face.

Most often, such measures quickly restore respiratory function. If there is no result and the child is not breathing, immediately perform artificial respiration and immediately call an ambulance.

Remember!

If your baby is premature and born early, you need to be prepared for possible apnea. Learn to give him the help he needs!

Pediatricians have the following algorithm of actions:

• There is a threat of aspiration - the baby falls face down . You can lay the baby on his side and carefully tilt his head back.
• Using a medical spatula, the child's mouth is opened . A mouth dilator is also used.
• The nasal and oral cavities are cleared of mucus using an electric suction and other means.

If necessary, artificial respiration is performed. When it is restored, humidified oxygen is connected. In difficult cases, they resort to hardware respiratory support. A qualified doctor will always provide more information on treatment.

Source: https://politermed.ru/articles/aktualnye-temy/apnoe-u-novorozhdennykh-priznaki-prichiny-lechenie.php

Apnea in an infant: symptoms, causes and treatment

Babies with sleep apnea sleep in strange positions and are often sleepy. Apnea disrupts the normal sleep cycle.

What is apnea?

Apnea is a condition in which a child stops breathing during sleep due to airway obstruction or improper breathing.

How common is apnea in babies?

Apnea most often occurs in children between two and six years of age, and less frequently in children under 6 months of age. In total, apnea occurs in approximately 3% of children under 13 years of age.

Types of apnea in babies

Apnea is divided into three types, depending on the cause.

· Obstructive apnea. Occurs when there is obstruction of the respiratory tract.

· Central. A less common type of apnea. It occurs due to improper functioning of the central nervous system; it begins to incorrectly regulate the breathing mechanism itself.

During normal functioning of the central nervous system, the brain sends an impulse to the muscles of the chest to expand and contract. In central apnea, muscles begin to move incorrectly due to insufficient stimulation from the brain.

Because of this, breathing becomes uneven and stops.

· Mixed apnea. A condition in which there is obstruction of the respiratory tract and the central nervous system.

What causes apnea in children?

So let's take a closer look at the causes of apnea in children.

· Adenoids and tonsils are lymphatic tissues that play an important role in preventing diseases. At the same time, the fact that they stop infections in their tracks and makes them more susceptible to them. Infected adenoids or tonsils become swollen and block the upper airway. This is the most common cause of apnea.

· Gastroesophageal reflux disease or acid reflux develops due to poorly developed esophageal sphincter. The sphincter does not close after swallowing food and acid from the stomach enters the throat and impairs breathing.

· Chronic congestion in the nose and lungs causes mucus to drain into the lower respiratory tract. Mucus can then rise up from the bronchioles and accumulate around the larynx, significantly narrowing the airways and causing obstructive sleep apnea.

· Diseases of the central nervous system can cause breathing problems and apnea. For example, a defect in the brain stem which is the area of ​​the brain that connects to the spinal cord. Any defect in this area will cause breathing problems.

· Exposure to drugs or chemicals such as painkillers can cause apnea as one of the side effects.

Some children are at higher risk of sleep apnea than others.

What factors increase the likelihood of sleep apnea in a child?

Presence of apnea in the family. It can be inherited.

High birth weight. Bigger children have more fat in the neck, which can put pressure on the airways.

Congenital physical defects. For example, children with jaw problems may have narrowed airways.

Congenital genetic problems. Down syndrome, Pierre-Robin syndrome.

Premature babies. Their respiratory system is poorly developed. And the central nervous system is not yet able to regulate breathing normally.

Children who live in the highlands or at higher elevations. Due to the high rarefaction of air.

Symptoms of apnea in children

Early diagnosis is the key to proper treatment. Here are the symptoms of apnea in children.

· Snoring and snorting. These are the most basic symptoms of breathing problems. And also long sighs.

· Pauses during breathing. If a child's chest stops moving for a few seconds during sleep.

· Unexpected awakenings. Due to lack of oxygen, the baby may wake up unexpectedly.

· Mouth breathing. The child breathes through the mouth due to insufficient air passing through the nasal passages.

· Sleeping in strange positions. Babies with sleep apnea arch their necks upward or roll to their sides to cope with blocked airways. The baby will also seem restless and change sleeping positions frequently.

· Long daytime sleep. Poor night sleep causes drowsiness and prolonged daytime sleep.

· The child has difficulty concentrating. Due to poor sleep and constant drowsiness, it is difficult for a child to keep his attention on games and entertainment. It may seem like a lack of attention and that the child is demanding it, but it is a lack of sleep.

· Nervousness and restlessness.

· Peeing in the bed, night terrors and nightmares . Children suffering from sleep apnea are more likely to have night terrors and nightmares.

However, these symptoms are characteristic not only of apnea; in this case, it is impossible to make a diagnosis independently based on these signs.

How is apnea diagnosed?

The following methods are used to diagnose apnea:

1. Physical examination. The size of the adenoids and tonsils is checked. Check to see if the child is breathing normally. An x-ray of the respiratory tract is taken.

2. Study of sleep in stationary conditions. If apnea is suspected, sleep monitoring may be performed in the hospital.

3. Monitoring sleep at home. For young children, parents monitor the child’s sleep at home and keep a diary of observations on the subject of: snoring, breathing problems, and so on.

How is apnea treated in children?

Treatment for apnea depends very much on the age of the child and what led to the disease itself. Here are the main treatment methods that are used for children from one year old.

1. Antibiotics for the treatment of tonsillitis and adenoids . If poor airway patency is a consequence of swelling of the tonsils or adenoids.

2. Surgery on the tonsils or adenoids. If their size does not allow them to be effectively treated with antibiotics, the doctor may prescribe surgery.

4. CPAP (continuous positive airway pressure). If other treatment methods do not work. A ventilator is used before going to bed, a mask is put on the child and the device maintains pressure, which forces the respiratory channel to be constantly open. Continues until symptoms disappear.

5. Losing weight. If apnea is caused by obesity, then it is necessary to follow a diet to bring the child to a normal weight.

What complications can apnea cause in a child?

If this condition is not treated, it can cause the following complications:

1. Lung damage. Due to the fact that the lungs do not receive enough oxygen, they lose functionality and develop poorly.

2. Cardiovascular problems. Low oxygen levels in the blood cause the heart to pump more blood. This increases blood pressure and puts extra strain on the heart.

3. Behavioral and developmental problems. Since children with apnea are constantly nervous, this can cause problems with learning and behavior.

4. Problems with nutrition and growth. Poor sleep can negatively impact your appetite and lead to poor weight and height gain.

What to do if a child with apnea stops breathing

Remember the following.

The pause in breathing is temporary. If you notice that the child has stopped breathing, it usually lasts no more than 20 seconds. Wait 20 seconds and check your breathing.

Nudge your child and change his position. If the child is not breathing, push him. He must wake up and breathe. You can also pick him up or change the direction of your head.

Wake up the child. If all else fails, try waking your child up more actively. This will send an alarm to the brain that may help you breathe.

Provide emergency resuscitation measures and call an ambulance. Perform resuscitation only if you know how to do it on a small child.

How to prevent apnea

Closely monitor your child's condition if he or she suffers from infections, especially of the throat.

Maintain your child's normal weight.

Buy a breathing monitor. If you are not sure whether your child has apnea, but have strong suspicions, then buy a monitor. It will constantly check the movements of the baby's abdomen and signal if they are absent.

Sources:

http://nsicu.ru/books/33/chapters/646

http://www.chop.edu/conditions-diseases/obstructive-sleep-apnea

http://www.sleepeducation.org/sleep-disorders-by-category/sleep-breathing-disorders/infant-sleep-apnea/symptoms-risk-factors

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004499/

http://kidshealth.org/en/parents/apnea.html

http://www.mayo.edu/diseases-conditions/central-sleep-apnea/symptoms-causes/syc-20352109

https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02026

https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/central-sleep-apnea/

https://web.stanford.edu/~dement/childapnea.html

https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02026

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