Medical Issues
This section of the website is devoted to medical issues and concerns that parents may have in relation to their premature baby. Anything contained in this section has been written by a member of the medical profession. We plan to get a number of articles briefly outlining some of the issues that effect preterm babies and parents.

GLOSSARY OF TERMS

ABR : Auditory brain stem response. A specialised hearing test

Anaemia : The number of baby’s red blood cells falls too low, making it harder for baby’s bloodstream to deliver oxygen throughout the body.

Apgar Score: Scale used to assess well being of a newborn baby at birth

Apnoea : Episode when baby stops breathing for a period of 20 seconds or more

Apnoea Monitor : Item of equipment that helps detect irregularities or cessation of breathing

Aspiration : Breathing any foreign matter or substance into the lungs usually milk or meconium

BAER Test : Brainstem auditory evoked response. A specialised hearing test

Blood Culture : A blood test to look for infection in the bloodstream

Bradycardia : A decrease or slowing of the heart rate, usually below 100 beats per minute in infants

Breast Milk Fortifier : A powder added to breast milk for preterm and small for gestational age babies. BMF’s contain extra energy, protein, vitamins and minerals to help the small baby grow better

Bronchopulmonary Dysplasia : Chronic lung disease is associated with respiratory distress and ventilation

Bayley Scales of Infant Development : Developmental assessment scale measuring cognitive, motor and behavioural development

Central Line : An IV placed in the arm, groin or chest that extents up into a large blood vessel.

Cerebral Palsy : Muscular and coordination problems as a result of a brain injury

CMV : Cytomegalovirus. A virus that can cause birth defects or various medical problems for very premature babies. It can be passed from mother to baby during pregnancy

CPAP : Continuous positive airway pressure. Air is blown continuously through baby’s nose or endotracheal tube to help keep baby’s lungs open between breaths. Used in situations where the baby doesn’t need full ventilator support but cannot breath well enough on his own

Cyanosis : Bluish colour of the baby’s skin usually caused by lack of oxygen

Desats : A drop in oxygen levels in the baby’s bloodstream. An alarm on the baby’s pulse ox monitor alerts the nurses if the baby de-sats

Echocardiogram : An ultrasound of the heart to assess heart function and looks for heart defects. It is non invasive and painless

EEG : Test that measures the electrical impulses of the brain

ECG : Test that measures the electrical activity of the heart

Endotracheal Tube : Tube placed in baby’s windpipe/trachea through his nose/mouth and which delivers oxygen to the lungs

Enteral Feeding : Feeding using the gut. Can be given through the mouth as oral feeds or through a tube as tube feeds

Extubation : The removal of an endotracheal tube

Expressed Breast Milk : EBM.Breast milk which has been expressed or pumped either by hand or by pump for babies who are unable to feed at the breast

Feeding Tube : A thin catheter inserted into babys stomach through the mouth or nose to provide breast milk or formula

Full Term Baby : Describes a baby born at 37 completed weeks gestation

Gestational Age : The number of weeks a baby is in the uterus

Gavage Feeding : Feeding delivered to the stomach via a gastric tube passed from the nose/mouth to the stomach

Heart Murmur : An extra humming sound heard while examining the heart. It is often a normal finding in preemies but occasionally can be a sign of a heart defect

Heel Prick : Procedure in which a tiny prick is made on the heel in order to get a sample of blood for laboratory analysis to out rule a metabolic disorder

Hypoxia : Temporary lack of sufficient oxygen in the baby’s blood

Intra Uterine Growth Retardation : IUGR. Describes babies who although mature are lighter in weight than would be expected

Intake : Volume of fluids and/medications given through intravenous (IV) lines and /or as tube feeds and/or as oral feed (e.g. breast or bottle feeds)

Incubator : A specially designed cot with a perspex cover. Used to provide warmth for preterm babies and sick infants

Intravenous Lines or Drips : IV stands for intravenous which means into a vein. Fluids, drugs and food in the form of specially prepared protein, carbohydrates and fat can be administered through these IV lines

IVH : Intraventricular haemorrhage. Bleeding within the ventricles in the brain

Jaundice : Yellow discolouration of the skin and whites of the eyes caused by build up of bilirubin. It is predominantly due to immaturity of the liver and resolves as the baby matures

Kangaroo Care : A method of caring for preemies that involves prolonged skin to skin contact

Low Birth Weight Formula : Infant formula milk which is designed for preterm and small for gestational age babies. It is fortified with extra energy, protein, vitamins and minerals to meet these babies increased needs

Lumbar Puncture : Spinal Tap. A needle is inserted between two vertebras in the lower back below the end of the spinal cord to collect spinal fluid for testing

Meningitis: An infection of the membrane surrounding the brain or spinal cord. It is diagnosed with a lumbar puncture or spinal tap to test the spinal fluid. It is treated with antibiotics

Meconium : Material present in the fetal intestinal tract. It is usually excreted after birth but may be excreted in utero before the baby is born

Monitor : Machine that records vital signs of heart rate, blood pressure and respiration

Mucus Plug : A thick plug of mucus that gets stuck within the lungs and blocks airflow

NG Tube : Nasogastric tube. A thin rubber tube passed through baby’s nose down into the stomach. It is used to feed baby breast milk or formula or to suction out excess stomach acid or mucus

NEC : Necrotizing Entercolitis. A serious condition in which a portion of the intestines is damaged

Neonatalogy : Branch of paediatric medicine which deals with newborn babies

Parenteral Nutrition : TPN. Nutrition that is administered directly into a vein for babies that are unable to take their milk

PDA: Patent Ductus Arteriosus. A heart condition in which an extra fetal blood vessel next to the heart remains open instead of closing after birth as it should

Phototherapy : A method used to treat jaundice. It consists of blue lights placed around the baby

ROP : Retinopathy of prematurity. A weakening of the retina in young preemies. It can cause long term problems with vision and is corrected with laser surgery

RSV : Respiratory Syncytial virus. A virus that causes a severe chest cold and wheezing.

Sepsis : A serious infection in the blood stream that can affect various organs and cause complications. It is treated with antibiotics and intensive care

Small For Dates : A term used for a baby who is born underweight for its gestation

Surfactant : Substance produced in the lungs to assist lung function. Often deficient in preemie it can be given through an ET tube to help improve immature lungs

TIN : Transient Tachypnea of the newborn. This is a short period of rapid breath (fast breathing) after birth, usually a caesarean section. It is only Transient and the baby usually makes a quick recovery

Total Parenteral Nutrition : TPN. Nutrition that is administered directly into a vein for babies that are unable to take their milk

Ventilator: A machine used to pump breaths of air through an ET tube into baby’s lungs
The Royal College of Obstetricians and Gynaecologists have kindly allowed us to use this article on GBS (group B streptococcus) for our website.

Preventing group B streptococcus (GBS) infection in newborn babies

• Key points
• About this information
• What is GBS?
• What could it mean for my baby?
• Are there tests for GBS?
• Why is there no national screening programme for GBS?
• What can help reduce the risk of GBS?
• What will my treatment involve?
• What treatment is available for my baby?
• Are there any risks with antibiotics?
• What might happen without treatment?
• Is there anything else I should know?
• Sources and acknowledgements
• Other organisations



Key Points


• Group B streptococcus (GBS) is one of many bacteria that normally lives in our bodies, including in the vagina and rectum, and usually causes no harm.
• About a quarter of pregnant women in the UK carry GBS in their vagina (this is called GBS carriage or colonisation with GBS).
• GBS carriage is not routinely screened for during pregnancy in the UK.
• GBS can be passed on from a mother to her baby. If this happens, it can occasionally cause severe illness in newborn babies. This is known as neonatal GBS.
• Out of every 2000 newborn babies in the UK and Ireland, only one is diagnosed with neonatal GBS, but it can be very serious.
• The risk of GBS being passed from a mother to a baby is highest during labour or at the time of the birth.
• If GBS is found in your vagina when you are pregnant, or if you have had a baby with neonatal GBS, you may be offered antibiotics during your labour.
• If your baby develops early onset neonatal GBS, he or she should be treated with antibiotics.
• It is recommended that you breastfeed your new baby in the usual way. Breastfeeding has not been demonstrated to increase the risk of GBS and will protect your baby against other infections.


About this information


This information is intended for you if you are expecting a baby or planning to become pregnant. It tells you about:
• Group B streptococcus (GBS) infection in babies in the first week after birth, otherwise known as early onset neonatal GBS infection, and referred to as ‘GBS’ throughout this information
• why GBS can be dangerous for newborn babies 
• the most effective ways recommended in the UK for preventing GBS in newborn babies.
It aims to help you and your healthcare team make the best decisions about your care. It is not meant to replace advice from a doctor, midwife or nurse about your own situation.
This information does not tell you about:
• why GBS causes symptoms in the newborn baby
• late-onset GBS, which occurs after the first week of birth 
• the reason some women carry GBS in their vagina during pregnancy and others do not.
If you would like further information on these topics, please ask your healthcare professional.
• Some of the recommendations here may not apply to you. This could be because of another illness you have, your general health, your wishes, or some or all of these things. If you think the treatment or care you get does not match what we describe here, talk about this with your doctor, midwife, nurse or another member of your healthcare team


What is GBS?


GBS is part of the streptococcus family. It is a common bacterium (not a virus) which, like several others, normally lives in your body, including in the vagina and rectum (known as GBS carriage or colonisation). GBS usually causes no harm. However, if GBS is passed on from the mother to her baby around the time of the birth this can occasionally cause serious illness for the newborn baby.


What could it mean for my baby?
About a quarter of pregnant women in the UK carry GBS in their vagina. Many babies therefore come into contact with GBS during labour or during birth, and GBS will colonise some of them. The vast majority of babies are not harmed by contact with GBS at birth.

A small number of babies, however, develop GBS infection and may become seriously ill.
Most babies who are infected show symptoms within 12 hours of birth. They may be floppy and unresponsive and may not feed well. Other symptoms may include grunting, high or low temperature, fast or slow heart rates, fast or slow breathing rates, irritability, low blood pressure and low blood sugar.

Out of every 2000 newborn babies in the UK and Ireland, only one is diagnosed with GBS infection; this means that about 340 babies each year are diagnosed with earlyonset neonatal GBS. Around one baby dies out of every ten who are diagnosed. Although it is rare, GBS is the most common cause of life-threatening infection in babies during the first week after birth.

For a few babies who become ill but who have already had antibiotics, the doctors may suspect the illness is due to GBS infection although it is not possible to confirm this diagnosis (as the antibiotics will have already killed the bacterium).

If there seems to be a higher risk of your baby being infected with GBS or if you have had a previous baby with GBS infection, you should be offered antibiotics during labour to reduce the chances of your baby developing the infection. Babies who show signs of GBS infection need to be treated with antibiotics to get well.

It is safe to breastfeed your new baby. Breastfeeding has not been demonstrated to increase the risk of GBS infection, and it protects against many other infections.


Are there tests for GBS?


GBS carriage may sometimes be detected during pregnancy in the course of tests for other infections by taking a sample by swab (similar to a cotton bud) from your vagina and/or rectum.

As GBS can cause urine infection in pregnant women, GBS infection may also be detected by taking a mid-stream urine sample (MSU), which is then sent to a laboratory for analysis. Urine infection caused by GBS should be treated with antibiotics.

Currently the evidence suggests that screening all pregnant women routinely would not be beneficial overall. You can be tested privately for GBS but the RCOG does not recommend this because a positive test may possibly result in unnecessary and potentially harmful interventions. If a test is done, the most sensitive method of detection requires swabs from the vagina and rectum that are cultured in the laboratory in a special solution. It is important to be aware that a negative swab test does not guarantee that you are not a carrier of GBS.
If there is a concern that a baby has GBS infection after birth, you will be offered treatment for your baby and testing to confirm that GBS is the cause of the infection. This testing will involve taking a sample of blood, or a sample of fluid from the spinal cord. Routine testing for GBS is not necessary.


Why is there no national screening programme for GBS?


You will not be offered a test routinely for GBS carriage during pregnancy as there is no national screening programme for this in the UK. There is conflicting evidence, and differing views, about whether a national screening programme would be effective. Research is being carried out to provide a clearer picture.

The RCOG guideline Prevention of early onset neonatal Group B streptococcal disease has carefully considered the benefits and harms of screening for GBS carriage during pregnancy. It agreed that there is still no clear evidence to show that screening all pregnant women in the UK would be beneficial overall. One of the potential harms of screening for GBS carriage during pregnancy is that large numbers of women would be given antibiotics during labour. The possible risks of this are:
• death or serious injury to a very few women from an allergic reaction (anaphylaxis) to the antibiotics
• strains of bacteria becoming resistant to antibiotics.


What can help reduce the risk of GBS?


In some circumstances antibiotics can help to reduce the risk of a baby developing GBS and so you may be offered antibiotics during labour if:
• GBS has been found in your urine in your current pregnancy 
• GBS has been found on swabs from your vagina and/or rectum which have been taken for another reason 
• you have previously had a baby with GBS infection 
• you are at higher risk of passing on GBS to your baby.This may be because: 
• you have a high temperature during labour
• you go into labour prematurely (prior to 37 completed weeks of pregnancy)
• you give birth more than 18 hours after your waters have broken.

Depending upon your particular circumstance, your healthcare professional will discuss the option of antibiotic treatment during labour.

Penicillin is normally given; if you are allergic to penicillin, you should be offered an appropriate alternative. If your doctor thinks you may have an infection but is not sure of the cause, you should be offered antibiotics that will treat a wide range of infections including GBS.
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When antibiotics are not necessary
If you carry GBS in your vagina, you should not need antibiotic treatment:
• if GBS was detected in your vagina in a previous pregnancy and the baby was not affected
• during pregnancy, unless you have a symptomatic infection (for example, a urine infection) though you may require antibiotics in labour. 
• if you have a planned caesarean section before you go into labour and before your waters break.
The reason why antibiotics are not usually needed in these situations is that the risk of your baby becoming infected with GBS is so low and because antibiotics do not reduce your chances of carrying GBS at the time of the birth.


What will my treatment involve?


If you need antibiotics during your labour, it is best if you can start them as soon as possible after your labour starts. This will be given through a vein (intravenously). You should be offered further doses as necessary until the birth.

If you need intravenous antibiotics, it may not be possible to give birth at home or in some midwifery units. This may be a factor in your decision on where you will give birth.

If you need antibiotics during labour there may be concern about the risk of infection for your baby if for some reason you were not able to receive them, or if you delivered very soon after receiving them. The best approach in these circumstances is not clear. The options of monitoring the health of your baby, or of treating him or her with penicillin, should be discussed between you and the medical staff taking account of the potential risks and benefits of each approach.


What treatment is available for my baby?


Babies with any signs of GBS infection, for example, if the newborn baby is floppy and unresponsive and does not feed well, should be treated with antibiotics as soon as possible.

If you have had a previous baby with GBS, your healthcare team should either monitor the health of your newborn baby closely for at least 12 hours after birth, or treat him or her with penicillin until blood tests confirm whether or not GBS is present.

Babies who show no signs of GBS and who are well do not routinely receive antibiotics or tests for GBS.
More research is needed before we can be sure about the best way to identify and treat babies who were at ‘higher risk’ of GBS during labour and who appear healthy after birth. Your healthcare professional will keep you informed about the need to test and treat your baby for GBS after birth.


Are there any risks with antibiotics?


Some women have a specific allergy to antibiotics (see section Why is there no national screening programme for GBS?). Some women may experience temporary side effects such as diarrhoea or nausea. However, for most women antibiotics are safe. Your doctor or midwife should discuss the benefits and risks of taking antibiotics during labour for you as an individual.

It is thought that babies exposed to antibiotics very early in their lives may have a higher than normal risk of asthma and/or other allergies later in life.


What might happen without treatment?


If your doctor recommends that you take antibiotics because of risk factors such as a high temperature in labour, and you choose not to, your baby may be at higher risk of GBS infection.
If your baby has GBS infection and is not treated with antibiotics, he or she is likely to become seriously ill and may die.


Is there anything else I should know?


• No screening test is entirely accurate. A screening test for GBS carriage could give a falsely negative result. In other words, a woman would be given a negative result when in fact she carried GBS in her vagina.
• No treatment can be guaranteed to work all the time for everyone. Even with antibiotic treatment in labour, some babies still develop GBS infection. 
• You have the right to be fully informed about your health care and to make decisions about it. Your healthcare team should respect these decisions.


Sources and acknowledgements
This information is based on the Royal College of Obstetricians and Gynaecologists (RCOG) guideline Prevention of early onset neonatal Group B streptococcal disease (which was published in November 2003 and is due to be reviewed in November 2006). This information will also be reviewed, and updated if necessary, once the guideline has been reviewed. The guideline contains a full list of the sources of evidence we have used.

Clinical guidelines are written to improve care for patients. They are drawn up by teams of medical professionals and consumers’ representatives, who look at the best research evidence available and make recommendations based on this evidence.

This information has been developed by the Patient Information Subgroup of the RCOG Guidelines and Audit Committee, with input from the Consumers’ Forum and the authors of the clinical guideline. It was reviewed by women attending clinics in Bristol, Liverpool and London. The final version is the responsibility of the RCOG Guidelines and Audit Committee.


Other organisations
These organisations offer support:

Group B Strep Support
PO Box 203
Haywards Heath
West Sussex RH16 1GF
Tel: +44 (0) 1444 416176 
Email: info@gbss.org.uk
Website: www.gbss.org.uk

The National Childbirth Trust
Alexandra House
Oldham Terrace
Acton
London W3 6NH
Tel: +44 (0) 870 7703236 
Email: enquiries@national-childbirth-trust.co.uk
Website: www.nctpregnancyandbabycare.com





© Royal College of Obstetricians and Gynaecologists 2006
The RCOG consents to the reproduction of this document providing full acknowledgement is made. The text of this publication may accordingly be used for printing with the addition of local information or as the basis for audiotapes or for translations into other languages. Information relating to clinical recommendations must not be changed.

Website: www.rcog.org.uk 
  • Premature babies-defintions
  • Premature baby Born before 37 weeks
  • Moderate Premature Born between 35 and 37 weeks
  • Very Premature Born between 29 and 34 weeks
  • Extremely Premature Born before 29 weeks
  • Low birthweight babies- definitions
  • Low birthweight baby Weighs less than 2,500 (5.5 lbs)
  • Very low birthweight baby Weighs less than 1,500 (3.0 lbs)
  • Extremely low birthweight baby Weighs less than 1,000 (2.2 lbs)

Respiratory Distress Syndrome

What is Respiratory Distress Syndrome?


Respiratory Distress Syndrome (RDS) is the most common lung disease of premature infants. RDS occurs in babies with incomplete lung development. The more premature the infant, the greater likelihood of RDS. RDS is due to insufficient surfactant in the lungs. Surfactant is a material normally produced by the lung that spreads like a film over the tiny air sacs allowing them to stay open. Open air sacs are essential for oxygen to enter the blood from the lung and for carbon dioxide to be released from the blood into the lung for exhalation.

What does a baby with Respiratory Distress Syndrome look like?

The baby will have difficulty breathing. S/he will have:

-rapid breathing

-pulling in of the ribs and center of the chest with each breath, called retractions.

-an "ugh" sound with each breath, called grunting.

-widening of the nostrils with each breath, called flaring.

How is RDS treated?



Your baby will need extra oxygen. Room air is 21% oxygen. Your baby needs higher oxygen to stay pink. The added oxygen might be given by placing a plastic hood over the baby's head. Your baby may need CPAP (Continuous Positive Airway Pressure). This is oxygen delivered under a small amount of pressure usually through little tubes that fit into the nostrils of the nose. Delivering oxygen under pressure helps keep the air sacs open. If the RDS is moderate or severe, your baby may need to have a breathing tube inserted into his/her wind pipe. This is necessary if your baby needs help with breathing or if your baby is to receive surfactant as a medication. Inserting the tube is called intubation. Once intubated, your baby may be placed on a breathing machine (respirator or ventilator) to help him/her breathe.

Your baby may be given surfactant, a drug which replaces the substance that your baby's lungs lack. This is given directly down the breathing tube. A baby must be intubated to receive surfactant. Your baby may have an umbilical arterial catheter (UAC) and/or an umbilical venous catheter (UVC) placed. This consists of placing a very small piece of tubing (catheter) into one or two of the blood vessels in the baby's umbilical cord stump. These catheters are used to:

give the infant needed fluids intravenously (by vein).

give the infant medications.

give the infant nutrients.

obtain blood samples from your baby without sticking him/her.

Frequent blood sampling is necessary to determine if the baby is receiving the right amount of oxygen, sugar water and other things to keep the body in balance. To determine the correct settings (oxygen, respiratory rate, etc.) on the breathing machine to meet your baby's needs. Your baby will be hooked up to one or more monitors. Wires will connect patches on your baby to the monitors. Your baby will be in a special bed to help keep him/her warm.

How long does RDS last?



For each baby the course is different. The disease usually gets worse for about 3-4 days. Then, the baby gradually needs less added oxygen. If a baby has relatively mild disease and has not needed a breathing machine, s/he may be off oxygen in 5-7 days. If a baby has more severe disease there is also improvement after 3-5 days but the improvement may be slower and the baby may need extra oxygen and/or a ventilator for days to weeks. Recovery is slower if:

the baby is very tiny (<2 1/2 pounds at birth)

the baby's disease was severe (required high oxygen and ventilator settings in the first days)

the baby also had infection

the baby had complications such as Pneumothorax, Pulmonary Interstitial Emphysema or Patent Ductus Arteriosus

How can I tell if my baby is getting better?

Your baby will breathe easier. The breathing rate will decrease.

Your baby will need less oxygen. The goal is to get down to room air, 21%.

If your baby is on CPAP, the amount of CPAP will be decreased and CPAP may be stopped entirely.

If your baby is on a breathing machine, the doctors will gradually change the settings on the machine to decrease the amount of work from the machine and increase the amount of breathing by the baby. The amount of added oxygen will also decrease.

Are there long term problems after RDS?

Long term problems are more likely if the disease has been severe or if there have been complications. Possible problems may include:

increased severity of colds or other respiratory infections, especially for the first two years.

increased sensitivity to lung irritants such as smoke, pollution.

greater likelihood of wheezing or other asthma-like problems in childhood than babies without RDS.

greater likelihood of hospitalization in the first two years of life than babies without RDS.

if the RDS was severe, the baby may have injury and scaring of the lung called Bronchopulmonary Dysplasia.

Will RDS cause developmental abnormalities?

RDS does not cause abnormal development. However, babies who are sick with RDS may have other problems that are associated with abnormal development.

What are jaundice and hyperbilirubinemia?

"Hyper" means high; "emia" means in the blood. Hyperbilirubinemia is a high level of bilirubin in the blood. Jaundice is the yellow colour to the skin that is often seen in the first few days after birth. The yellow colour is due to bilirubin.

What is bilirubin?

Bilirubin is produced when red blood cells get old and are broken down by the body. Normally it is processed in the liver and then deposited in the intestine so it can come out in the stool.

Why do babies have jaundice?

The red blood cells of babies have shorter lives than adult red blood cells; bruising at birth may cause a larger number of red cells to be broken down. All of the bilirubin from these cells needs to be processed by the baby's liver. Premature babies do not have fully developed organs. Their livers cannot process bilirubin rapidly. Their intestines may not move much in the first few days especially if they are sick and not being fed.

Is bilirubin bad?

Small or moderate increases in bilirubin are not harmful. Extremely high levels of bilirubin can be harmful, causing brain damage. Your baby's bilirubin will be measured if s/he becomes jaundiced to be sure that s/he does not come close to having harmful levels.

How is jaundice treated?

If the level of bilirubin is high enough to need treatment, it is usually treated with phototherapy. This means the undressed baby is placed under special lights. The lights may be white, blue, or green. Or, the baby can be placed on a light producing blanket. The light helps break down the bilirubin in the skin. It may cause the baby to have runny stools.

Why are babies' eyes covered when they are having phototherapy?

It may not be good for babies to have bright light continuously shining in their eyes. The eyes are covered to protect them from so much light.

How long will my baby have jaundice?

The duration of jaundice varies greatly from baby to baby. Bilirubin levels increase over the first several days and then fall slowly. Phototherapy is usually needed for a few days, but occasionally for more than a week. Babies receiving breast milk may remain yellow longer than those receiving formula, but usually these low levels are not harmful.

What happens if a baby's bilirubin rises close to dangerous levels?

It is very uncommon for premature infants to need any treatment other than phototherapy. However, if a baby's bilirubin gets close to harmful levels, the doctor can do an exchange transfusion, a procedure where the baby's blood containing the bilirubin is replaced with blood from the blood bank. Also, this can be done if a baby's mother has made antibodies against the baby's blood and the antibodies are destroying the baby's red blood cells. This, too, is uncommon in premature infants.

What is apnoea?

Apnoea is a pause in breathing that has one or more of the following characteristics Apnoea is a pause in breathing that has one or more of the following characteristics:

lasts more than 15-20 seconds
is associated with the baby's color changing to pale, purplish or blue
is associated with bradycardia or a slowing of the heart rate

What is bradycardia?

Bradycardia is a slowing of the heart rate, usually to less than 80 beats per minute for a premature baby. Bradycardia often follows apnoea or periods of very shallow breathing. Sometimes it is due to a reflex, especially with the placing of a feeding tube or when the baby is trying to have a stool.

Is all apnoea due to prematurity?

No, apnoea of prematurity is by far the most common cause of apnoea in a premature infant. However, apnoea can be caused or increased by many problems including infection, low blood sugar, patent ductus arteriosus, seizures, high or low body temperature, brain injury or insufficient oxygen.

Why do premature babies have apnoea?

Premature babies have immature respiratory centers in the brain. Preemies normally have bursts of big breaths followed by periods of shallow breathing or pauses. Apnoea is most common when the baby is sleeping.

Will apnoea of prematurity go away?

As your baby gets older, his/her breathing will become more regular. The time course is variable. Usually apnoea of prematurity markedly improves or goes away by the time the baby nears his/her due date.

How is apnoea treated?

Several treatments are possible. Your baby may be treated with one or more of the following:

-Medications that stimulate breathing.
-CPAP or continuous positive airway pressure. This is air or oxygen delivered under pressure through little tubes into the baby's nose.
-Mechanical ventilation (breathing machine). If the apnoea is severe, the baby may need a few breaths from the ventilator every minute. These might be given at regular intervals or only if apnoea occurs.
-A rocking bed or periodic stimulation

How do I know if my baby has apnoea?

Your baby's respirations are monitored continuously if s/he is at risk for apnoea. An alarm will sound if there is no breath for a set number of seconds.

What happens if the monitor sounds?

A nurse will observe your baby to see if s/he is breathing, if there is a change in color or if the heart rate is falling. False alarms occur often. The nurse may stimulate your baby if your baby needs a reminder to breathe. If there is a change in color, the nurse may give your baby extra oxygen.
If your baby still doesn't breathe, s/he may give the baby a few breaths with a bag and mask, or extra breaths on the mechanical ventilator.

Does my baby have to stay in the hospital until the apnoea goes away completely?

Most infants are over their apnoea completely when they go home; however, some babies reach all other criteria for discharge before their apnoea is completely gone. Some babies are candidates for home apnoea monitoring. Your baby may be a candidate for home apnoea monitoring if:

-s/he has apnoea that is short and s/he recovers without any stimulation
-s/he has no color change or bradycardia with the apnoea
-the apnoea is not expected to go away in the next several days
-your nursery has a home apnoea program
-you have a phone and live near emergency help (if you would need it)
-you, and usually a second person, have completed home apnoea training and a course in cardiopulmonary resuscitation of a baby
-your baby's doctor feels this is a good idea for your particular baby

Once apnoea goes away, will it come back?

Apnoea of prematurity is a result of immaturity. Once a baby matures and the apnoea resolves, it will not return. If a baby should have breathing pauses after apnoea goes away, it is not apnoea of prematurity. It is due to some other problem and needs to be discussed with your baby's physician. This is not common.

Is apnoea of prematurity related to sudden infant death syndrome (SIDS)?

No, these are two entirely different problems. Most babies who die of SIDS are born at term and have normal newborn stays. Babies who have needed newborn intensive care for any reason are at a slightly higher risk of SIDS than other babies. Apnoea of prematurity does not determine this risk.
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