Apnea (ER Story)

it can be one of the more terrifying experiences faced by a new parent: your baby is fine one moment… and then suddenly stops breathing the next. That’s the troubling reality facing one family whose baby ended up in the ER.

Each night for the last week, five-week-old Shawnee has had repeated episodes of apnea…

“Apnea, or the absence of effort to breathe, where you stop breathing at all, can be deadly for babies. And a lot of what we consider sudden infant death syndrome has to do with apnea,” explains Dr. David Goo in the Emergency Pediatrics department at Children’s Health Care of Atlanta

Shawnee is hooked up to a special monitor that sounds an alarm when she stops breathing. The information is time-stamped and recorded.

In the Pediatric Sleep Lab, Dr. Gary Freed goes over the results, which show frequents spells of apnea during a brief period. “Well this is 4:43, 4:44, 4:48, 4:49. So these four periods were within six minutes.”

The apnea started when she was one week old. It is not the same as sleep apnea, which is more common in adults…

“This type of apnea in babies is due to immature brain,” explains Dr. Goo. “And you don’t get the stimulus to breathe as strongly as adults and older children will get that stimulus.”

She’ll need a spinal tap and more tests to see if any infection is present. In the meantime, she’ll get a commonly used substance to help her breathe… caffeine.

“Caffeine, as you know, usually helps with apnea. That’s why [she’s] on it,” Dr. Goo tells Shawnee’s parents. “And so what it does is stimulate the brain to breathe and decreases the periods of apnea.”

He says apnea in babies is rare, but when parents do notice it, “Talk immediately to your pediatrician about that. And they can arrange for the proper studies. And if you need an apnea monitor, they’ll get you one.”

As for Shawnee, more tests lie ahead. For now, she’ll remain hooked up to the monitor, while her doctors try to figure out what’s causing the apnea.

Dr. Goo tells her mother the doctors will be, “Checking the labs and then seeing what the monitor download was. And then maybe we can get an answer for you.”

And two weeks after she was admitted to the ER, there’s good news for Shawnee and her parents. Dr. Goo says after she received oxygen and an increased dose of caffeine, her apnea subsided. As of this time, she appears to have fully recovered.

According to the U.S. Food and Drug Administration (USFDA), infant apnea falls into one of the following three categories:

• Central or diaphragmatic – The baby makes no effort to breathe; the chest is still, and no air passes through the mouth or nose.
• Obstructive – The chest is moving but no air passes through the mouth or nose (usually due to soft tissue such as the tongue blocking the upper airway).
• Mixed – The infant has episodes of both central and obstructive all within the same event.

If your child’s pediatrician gives you an infant apnea monitor to keep track of your child’s sleeping habits, experts at the USFDA recommend the following tips:

• Keep children and pets away from the monitor and the baby to prevent the monitor from being accidentally disconnected.
• Test the monitor before each use to ensure the alarm is working.
• Make sure the monitor’s breath detection indicator light flashes only once for each breath the baby takes while the baby is still (the light may also flash when the baby moves). If the baby is still and the light does not flash in unison with his or her breathing, contact your equipment provider immediately.
• Make sure battery and charger connections are tight. If the monitor has a light that indicates when the battery is charging, it should not flicker when the connectors are gently wiggled or twisted.
• Follow the manufacturer’s recommendations and report problems to the monitor provider or, if the provider can’t help you, to the manufacturer.

Children’s Healthcare of Atlanta
Children’s Healthcare of Atlanta Emergency Services
U.S. Food and Drug Administration