From the Guidelines
Neonatal apnea is primarily caused by immaturity of the respiratory control center in the brain, particularly in premature infants, and can also be caused by central sleep apnea, which is more common in infants with Prader-Willi syndrome, as reported in a 2022 study 1. The most common type of apnea in neonates is apnea of prematurity, occurring in babies born before 37 weeks gestation. Other significant causes include:
- Infection (sepsis, meningitis, pneumonia)
- Neurological disorders (intracranial hemorrhage, seizures)
- Respiratory conditions (respiratory distress syndrome, airway obstruction)
- Metabolic disturbances (hypoglycemia, electrolyte imbalances)
- Temperature instability (hypothermia or hyperthermia) Gastrointestinal issues like necrotizing enterocolitis or reflux can trigger apnea, as can certain medications, particularly those with sedative effects. Anemia can reduce oxygen-carrying capacity, contributing to apneic episodes. Congenital abnormalities affecting the airway or central nervous system may also cause apnea. The use of supplemental oxygen has been shown to be an effective treatment in infants with central sleep apnea, and is the therapy of choice for this age group, as stated in a 2022 study on the diagnosis and management of sleep disorders in Prader-Willi syndrome 1. Management typically involves treating the underlying cause, respiratory support as needed, and in cases of apnea of prematurity, caffeine citrate (loading dose 20 mg/kg, maintenance 5-10 mg/kg daily) is the first-line pharmacologic treatment to stimulate respiratory drive. Close monitoring is essential as apnea can indicate serious underlying conditions requiring prompt intervention.
From the FDA Drug Label
PRECAUTIONS General Apnea of prematurity is a diagnosis of exclusion. Other causes of apnea (e.g., central nervous system disorders, primary lung disease, anemia, sepsis, metabolic disturbances, cardiovascular abnormalities, or obstructive apnea) should be ruled out or properly treated prior to initiation of caffeine citrate. The causes of apnea in neonates include:
- Central nervous system disorders
- Primary lung disease
- Anemia
- Sepsis
- Metabolic disturbances
- Cardiovascular abnormalities
- Obstructive apnea 2
From the Research
Causes of Apnea in Neonates
- Apnea in neonates can be caused by immaturity of the central nervous system, also known as apnea of prematurity 3, 4, 5
- Secondary causes of apnea, such as metabolic disturbances, should be excluded before a diagnosis of apnea of prematurity is made 3, 6
- In term infants, apnea can be caused by various factors, including positional or feeding etiologies, or may be a manifestation of serious pathophysiology, such as a seizure disorder 7
- Genetic predisposition may also play a role in the development of apnea of prematurity 4
Pathogenesis of Apnea
- Apnea of prematurity is probably a manifestation of physiologic immaturity of breathing control rather than a pathologic disorder 4
- Immature breathing responses to hypoxia, hypercapnia, and exaggerated inhibitory pulmonary reflexes in preterm infants may contribute to the occurrence or severity of apnea of prematurity 4
- Central inhibitory neuromodulators, including prostaglandins, GABA, and adenosine, may also be involved in the pathogenesis of apnea of prematurity 4