APNOEIC ATTACKS IN CHILDREN

These are cessation of breathing for 15–20 seconds, often accompanied by bradycardia. Apnoeic attacks are most commonly due to prematurity, but may accompany sepsis, hypoglycaemia, hypoxaemia, hypothermia, hyperthermia.

Clinical Features

  • Apnoea
  • Bradycardia
  • Cyanosis
  • Features of the predisposing condition.

Investigations

  • Screen for sepsis – full blood count, blood culture
  • Blood glucose levels

Management

  • Re-establish breathing by gentle stimulation. If poor response ventilate using bag and mask.
  • For apnoea of prematurity give caffeine citrate 20mg/kg orally or IV over 30 minutes. If caffeine is not available use IV aminophylline 10mg/kg over 15–30 minute. Maintenance doses should be given at 5mg/kg/day. Avoid rectal
    aminophylline; it may not achieve therapeutic levels. In all cases monitor heart rate.
  • IV fluids according to the daily needs.
  • Avoid oral feeding to prevent aspiration
  • Treat the cause if known.
  • If frequent give continuous oxygen by nasal catheter.
  • In recurrent cases continuous positive airway pressure (CPAP) may be useful. This can be done in a neonatal intensive care unit (NICU)
  • Monitor frequently.