Apneic episodes in full-term newborns

amother

Mon, Jan 29 2024, 7:05 pm

Have you had this with your child? I'm talking about apnea in a one or two day old baby, not a preemie.
Wondering about your experience. How long did it take to resolve? What was the cause ?

amother

Steel

Mon, Jan 29 2024, 7:21 pm

My child had this. He turned blue a couple of hours after birth and stayed in the hospital 10 days while they ran tests. No cause was found but they figured his lungs were immature in function even though he was full term. Was treated with caffeine for a year and had apnea monitoring for 6ish months (full time for a while and cut back to just overnight over time). BH just outgrew it.
My next child was monitored for apnea as soon as he was born but BH never had it.

The monitoring was very difficult as he frequently pulled off the leads and set off the alarm and we would jump every time. But even with the false alarms, over time the number of alerts per night clearly decreased and we began to relax.

amother

Mon, Jan 29 2024, 7:27 pm

amother Steel wrote:

Thanks. Can I ask if you were in the US or in Eretz Yisroel?

amother

Buttercup

Mon, Jan 29 2024, 7:30 pm

I had this

ran around to doctors
Turned out it was reflux related. Baby had a hard time catching his breath because of reflux coming up.
Even medication didnt resolve it completely

If baby is changing colors or theres any scary looking reactions I would run check it out.
But if it's just a matter of stopping to breathe and then taking a gasping breath, this very well might be the case

Took a long time to fix itself, at age of 3 was still happening once in a whilewhile

amother

Mon, Jan 29 2024, 7:53 pm

amother Buttercup wrote:

How old was the baby? Was he admitted to the hopsital?

amother

Steel

Mon, Jan 29 2024, 7:57 pm

amother OP wrote:

Thanks. Can I ask if you were in the US or in Eretz Yisroel?

US- NY at a major medical center
They tested for very rare and scary conditions for a week to rule them out before treating with caffeine (which would have been contraindicated if he had had one of those syndromes). People have told me that in EY they would not have done that but treated for the most common causes right away (I don’t know if that’s true.)

At first the apnea was frequent and severe enough that he needed to be intubated (which was beyond horrible). After he breathed more regularly they put him on CPAP and a few days later were able to remove the breathing support and send him home.

amother

Mon, Jan 29 2024, 8:00 pm

amother Steel wrote:

I'm asking, because I have a baby at Columbia for the last 11 days who has this. Been tested for everything, all came out negative.
But I haven't heard anything about caffeine, except from someone who was treated for apneic episodes in EY.
I was also told that the baby won't be going home with a monitor. So that's why I asked.
Did your baby have a feeding tube?

amother

Steel

Mon, Jan 29 2024, 8:07 pm

amother OP wrote:

I’m so sorry I know what a nightmare this is.
We were at montefiore (and this was many years ago so medical practice may have changed.) even at the time they told us the monitor was more for our assurance and they would not have sent him home if he really needed constant monitoring. We were very nervous taking him home and honestly might have preferred he stay longer!

If I remember right they said caffeine was routinely given to preemies to help lung function and since they found no other cause they treated him as a preemie.

He did not have a feeding tube as BH he was able to nurse as soon as they disintubated him.

amother

Steel

Mon, Jan 29 2024, 8:12 pm

This is from 2020:
https://openres.ersjournals.co.....ment.

Conclusions

In preterm infants, caffeine is effective in reducing apnoea frequency, the need for IPPV and mechanical ventilation, as well as enhancing the success of extubation. In addition, caffeine-treated newborns have lower rates of BPD, IVH and PDA, with positive long-term outcomes on pulmonary function and neurodevelopment. Despite the longstanding use of caffeine in the neonatal intensive care units, controversies regarding the optimal timing and dosage of caffeine therapy still remain [123], as the majority of data on long-term outcomes and safety stem from one randomised placebo-controlled trial [33]. Furthermore, the role of therapeutic drug monitoring needs to be addressed. The paucity of data on caffeine metabolism related to clinical outcomes in extremely preterm neonates highlights the importance of further research in this field in order to better refine the respiratory management of these subjects.

amother

Mon, Jan 29 2024, 8:26 pm

Interesting. We have not heard one word about caffiene.
We were also told that the lungs seem fine...maybe that's why? Is the caffeine for the lungs?
We are being told that there is possibly miscoordination.

amother

Steel

Mon, Jan 29 2024, 8:29 pm

amother OP wrote:

Yes that makes sense - if there is no concern about the lungs there may be no reason to use caffeine. But don’t hesitate to ask your doctor!

amother

Hawthorn

Mon, Jan 29 2024, 8:38 pm

honey36 wrote:

Have they ruled out laryngomalacia?
Also this is going to sound crazy, but I have heard tongue tie can cause apnea in babies as well.

It’s not crazy. I heard it too. It makes sense too.

amother

Mon, Jan 29 2024, 8:43 pm

How does one check for these things? He had an ENT scope, but only a surface check. They could not rule out a laryngeal cleft without sedating the baby.
I did ask about tongue tie and was told he does not have it.

amother

IndianRed

Mon, Jan 29 2024, 9:51 pm

amother OP wrote:

Did they put the scope all the way up his nose and down his throat to confirm that both nasal passages are open all the way? Or did they just look inside superficially?

amother

Mon, Jan 29 2024, 10:14 pm

amother IndianRed wrote:

Did they put the scope all the way up his nose and down his throat to confirm that both nasal passages are open all the way? Or did they just look inside superficially?

I actually wasn't there at the time, so km not sure.
But he has had an NG tube in both nostrils, if that answers the question.

amother

IndianRed

Mon, Jan 29 2024, 10:37 pm

amother OP wrote:

I actually wasn't there at the time, so km not sure.
But he has had an NG tube in both nostrils, if that answers the question.

Yes, that's just as good as a scope. So both nasal passageways are totally open.

As far as the lip/tongue issues, newborns are nose breathers. Normal newborns never breathe through their mouth.

So if it's not an anatomical issue, it's most likely caused by the central nervous system.

Refuah Shelaima!

amother

Mon, Jan 29 2024, 10:40 pm

amother IndianRed wrote:

He does just fine with a paci in his mouth. So I think he breathes well through his nose.
He desats while sleeping and also while feeding by mouth. Also when he has just calmed down after being agitated. It's not clear if it's related to food or not.