obsolete apnea of prematurity

Apnea of prematurity (AOP) was once considered a condition that affected premature infants, characterized by pauses in breathing for more than 15 to 20 seconds during sleep. However, with advancements in medical understanding and treatment, the concept of AOP has evolved.

Definition and Incidence In the past, apnea of prematurity was defined as a condition where premature infants stopped breathing for more than 15 to 20 seconds during sleep (3). It was nearly universal among very preterm infants, but neither the apnea burden nor its clinical associations had been systematically studied (4).

Causes and Symptoms The causes of AOP were attributed to central nervous system immaturity (central apnea), with episodes of prolonged apnea potentially leading to bradycardia or oxygen desaturation (cyanosis) in neonates born at 37 weeks gestation (14). The symptoms included repetitive, acute, and symptomatic cardiorespiratory events manifesting in a preterm infant (6).

Treatment Goals The principal goals of treating AOP were to address its cause and provide appropriate medical management (8). However, with the advancement of medical knowledge, the focus has shifted towards understanding the pathogenesis and treatment of apnea in premature infants.

Current Understanding Apnea of prematurity is now recognized as a developmental disorder affecting most infants born at less

Apnea of prematurity (AOP) is a condition that affects premature babies, characterized by pauses in breathing or shallow breathing patterns. While AOP is not typically considered "obsolete," as it still affects premature infants today, the signs and symptoms associated with this condition have been well-documented over the years.

Common Signs and Symptoms:

• Pauses in breathing for 20 seconds or more (1, 5, 10, 14)
• Bluish color to the skin (cyanosis) due to low oxygen levels (10,

Apnea of prematurity, although considered an outdated term, was once used to describe a condition where premature babies experienced pauses in breathing. While the term is no longer commonly used, understanding its diagnostic tests can provide insight into the medical evaluation of similar conditions.

Diagnostic tests for apnea of prematurity typically involved monitoring the baby's vital signs and conducting various blood tests. Some common tests included:

• Blood oxygen levels: This test measured the level of

Treatment Options for Apnea of Prematurity

Apnea of prematurity (AOP) is a condition that affects premature infants, characterized by pauses in breathing. While it's considered an outdated term, the treatment options mentioned below are still relevant to the management of AOP.

• Methylxanthines: These substances, found in high concentrations in tea, coffee, and chocolate, have been used to treat AOP (8). Methylxanthines, such as caffeine and theophylline, work by stimulating the respiratory system and increasing breathing rate (3, 7).
  • Caffeine citrate: This is considered the drug of choice for pharmacological treatment of AOP (4, 6). Caffeine citrate has been shown to reduce the frequency of apnea and the need for mechanical ventilation during the first seven days of therapy (7).
• High-flow nasal cannula: Using a high-flow nasal cannula may help open the airway enough to reduce obstructive apnea (5).

Other Treatment Considerations

While these treatment options are still relevant, it's essential to note that AOP is now considered an outdated term. The condition has been reclassified under more specific categories.

• Standard preterm care strategies: In addition to pharmacological treatments, standard preterm care strategies are crucial in caring for infants with apnea (9).
• Monitoring and management: Close monitoring and proper management of the infant's respiratory system are essential to prevent complications and ensure optimal outcomes.

References

(3) Schmidt B. Methylxanthines reduce the frequency of apnea of prematurity and the need for mechanical ventilation during the first seven days of therapy. [7]

(4) Long JY. Caffeine citrate is the drug of choice for the pharmacological treatment of apnea of prematurity. Factors such as maturity and genetic variation contribute to... [6]

(5) Dec 14, 2022 — Use of a high-flow nasal cannula may open the airway enough to reduce obstructive apnea. As an alternative, high-flow oxygenation through a... [5]

(7) Schmidt B et al. (2006). Caffeine for Apnea of Prematurity Trial Group: Caffeine therapy for apnea of prematurity. N Engl J Med;354:2112–2121.

(8) Oct 4, 2023 — Apnea in preterm babies is commonly treated with methylxanthines – substances found in high concentrations in tea, coffee, and chocolate. [8]

(9) Dec 14, 2022 — These include altered ventilatory responses to hypoxia, hypercapnia, and altered sleep states, while the roles of gastroesophageal reflux and anemia... [5]

Apnea of prematurity (AOP) was once considered a common condition in premature infants, but its prevalence has decreased over the years due to advances in neonatal care and respiratory support.

Causes of AOP

In the past, AOP was attributed to various factors, including:

• Respiratory immaturity: The immature respiratory system in preterm infants made them more susceptible to apneic episodes.
• Neonatal disease: Infections, metabolic derangements, and other neonatal conditions could contribute to AOP.
• Hypoxia and hypercapnia: Altered ventilatory responses to low oxygen levels (hypoxia) and high carbon dioxide levels (hypercapnia) were also implicated.

Differential Diagnosis

When evaluating premature infants for apnea, healthcare providers would consider the following differential diagnoses:

• Apnea of prematurity: As mentioned earlier, AOP was once a common condition in preterm infants.
• Infection: Sepsis and other infections could cause apneic episodes in neonates.
• Metabolic derangements: Conditions like hypoglycemia or electrolyte imbalances could contribute to apnea.
• Airway obstruction: Obstruction of the airway, either due to anatomical issues or foreign bodies, was also considered.

Current Understanding

While AOP is still a concern in preterm infants, its prevalence has decreased significantly. Modern neonatal care and respiratory support have improved outcomes for these vulnerable patients. However, it's essential to remain vigilant and consider the differential diagnoses mentioned above when evaluating premature infants for apnea.

References:

• [1] Apnea of prematurity (<35weeks): The most common cause of apnoea, attributable to the immaturity of the respiratory centre in the brain. · Airway obstruction: ...
• [3] by J Pergolizzi · 2022 · Cited by 15 — Premature babies often suffer apnea of prematurity as a physiological consequence of an immature respiratory system.
• [11] Apnea of prematurity (AOP) is a diagnosis of exclusion. For many diseases in preterm infants, apnea is a presenting symptom.
• [12] The pathogenesis, diagnosis, and clinical presentation of apnea of prematurity are reviewed here.