What is Apnea of Prematurity (AOP)?

Worried that their infants may stop breathing, many new parents check on their sleeping babies, but for Nicole Trout of Missouri, this fear was very real. Her daughter, Casey, born four months early and weighing 1 pound, 10 ounces, frequently stopped breathing during her 104-day stay in the hospital. Fortunately, a monitor signaled the nurses to come quickly and help Casey begin breathing again.

Casey experienced apnea of prematurity, or AOP, pauses in breathing that lasted 20 seconds or more. Changes in a baby's color to pale, bluish or gray, a change in muscle tone to limp or rigid, and a slow heart rate (called bradycardia) often accompany AOP.

The Facts on AOP

Caused by immature respiratory centers in the brain (the brain isn't able to remind the lungs to breathe on a regular basis), apnea is the most common problem of babies born early, and in fact, about 70 percent of those born six weeks early are affected by AOP. Other common problems including infection, low blood sugar, a lack of oxygen, or a digestive problem can also cause apnea.

If a baby has apnea, "it will generally be seen during the first week following birth," says Berry Peterson, a pediatric nurse practitioner at The Apnea Center of Children's Healthcare of Atlanta. Preemies at risk for apnea are hooked to a cardiorespiratory monitor, and wires or a belt leading to the monitor are attached to the baby's chest. The monitor sounds an alarm if it doesn't detect a breath for a preset number of seconds. Treatment includes periodic stimulation that reminds babies to breathe (some hospitals even have beds that rock), medication that stimulates breathing and/or supplemental oxygen.

According to Peterson, preemies typically outgrow AOP about a month after their full-term due date. Depending on the baby's health, this may mean going home on a monitor.

Monitoring at Home

Criteria for discharging a baby on a monitor varies, but if your baby has unresolved apnea, has experienced a life-threatening apnea episode, or is going home with supplemental oxygen or a tracheotomy, you'll probably be taking a monitor home.

An article by Dr. Rene Santin, a neonatologist at Albert Einstein Medical Center in Philadelphia, reports that as many as 15 percent to 20 percent of the 400,000 preemies born each year are treated with home monitoring. But don't panic: Your baby doesn't have to wear the monitor 24/7. In fact, it's only needed when your baby is unattended, such as during sleep and while riding in the car.

Parents often find the monitor alarms both comforting and frightening. "When Casey first came home, I wasn't sure if I'd hear the alarms or if the monitor would work so I wouldn't sleep," says Trout. "I felt like my baby's life was depending on a machine." But Trout says she soon learned to trust the monitor and herself.

According to experts, about 70 to 75 percent of alarms are false, most often caused by loose wires, a poor connection, or Baby's movement. That's why it's important for parents to evaluate their baby's color, muscle tone, and breathing, says Peterson. "If the baby is not breathing, gently stimulate by flicking the bottom of the feet or rubbing the chest," he says. "If that doesn't help, pick the baby up and pat on the back [but never shake a baby]. If the alarm persists, begin CPR and call 911."

The Apnea Center of Children's Healthcare is one of the largest facilities in the United States that provides monitoring and interpreting of apnea alarms for doctors who may adjust medication or supplemental oxygen. Parents download information through the telephone modem to relay their baby's information. In other communities, respiratory therapists visit the home and call in information to doctors. Peterson says that parents play an important role by charting apnea episodes and other important information, such as what the baby was doing during the episode, the baby's physical characteristics, and what action was necessary.

5 Home-Monitoring Tips

Here are some suggestions from Your Premature Baby and Child: Helpful Answers and Advice for Parents for making life with a monitor easier for you and your baby:

• Before homecoming take an infant CPR class and stay overnight in the hospital to become more comfortable with the monitor. Make sure your baby's caregivers take infant CPR classes, too.
• Keep CPR instructions and emergency phone numbers near the monitor and ensure that your house or apartment number is visible to emergency personnel.
• For priority reconnection following a power failure, notify utility companies that your baby needs a monitor.
• Place the monitor away from sources of interference (baby monitors, cordless phones, and televisions) and plug into a grounded outlet.
• Keep a lamp or a flashlight near your baby's bedside for nighttime alarms.

Outgrowing AOP

Most preemies no longer require a monitor when they've outgrown AOP and do not require medication. "Our recommendation is that the baby be event-free for three months, but some doctors require less time," Peterson says. Parents should ask their doctors for individual criteria.

Once AOP resolves, it will not return and no correlation between AOP and sudden infant death syndrome (SIDS) has been found. As for Casey and her mom, being monitor-free may be only a few weeks away. It's been more than a month since Casey's last apnea episode and Trout reports that the nights are much more restful.