Apnoea and Monitors

What apnoea of prematurity is

Apnoea of prematurity is a pause in breathing in a baby born early. It is not caused by anything being wrong with the lungs. It is caused by the part of the brainstem that drives regular breathing not being finished yet, which is why it is closely tied to gestational age and why it goes away with maturity rather than with treatment.

March of Dimes describes the pattern parents see on the monitor: "A baby with apnea may take a long breath, then a short one, then pause for 15 to 20 seconds before starting to breathe again." That pause often drags the heart rate down with it.

A's and B's, and desaturations

You will hear staff talk about A's and B's. A is apnoea, the breathing pause. B is bradycardia, a slow heart rate, which March of Dimes notes is "often caused by interrupted breathing called apnea". Alongside those you will hear "desats" — drops in the oxygen saturation reading from the probe on your baby's hand or foot.

These three travel together and staff record them as episodes: how many, how long, how deep, and how much was needed to bring the baby back. That last part is what actually matters. An episode that resolves on its own is a different event from one where a nurse had to rub your baby's back, which is different again from one needing extra oxygen or breathing support. When you ask about a bad night, ask about the handling, not the count.

What the monitor is telling you, and what it is not

The monitor shows heart rate, breathing rate and oxygen saturation. NICE guideline NG124 recommends continuous pulse oximetry in preterm babies, and, after initial stabilisation, aiming for an oxygen saturation of 91% to 95%. NICE also warns that pulse oximeters can under- or overestimate saturation, particularly at borderline levels, and that overestimation has been reported in people with dark skin.

Alarms are set tight on purpose, and most of them are not events. A probe that has slipped, a baby who has wriggled, a limb that has gone cold: all of these alarm. Staff look at the baby and the trend before they look at the number. Within a week or two you will find yourself doing the same, and that is a healthy adaptation rather than complacency.

Caffeine

Caffeine citrate is the standard treatment, and it is one of the most effective drugs in neonatal medicine. It stimulates the respiratory centre and reduces both apnoea and the need for ventilation.

NICE NG124 recommends using caffeine citrate routinely in preterm babies born at or before 30 weeks, starting as early as possible and ideally before three days of age, and considering it for any preterm baby with apnoea. It is given as a loading dose and then a once-daily maintenance dose, adjusted by the team; the dose is a hospital prescribing decision and is off-label at some of the levels NICE describes, so it is not a number for a parent to work with.

The stopping point is more useful to know: NG124 says to consider stopping caffeine at 33 to 35 weeks' corrected gestational age if the baby is clinically stable. Units then usually watch for a period — often around a week — to confirm the apnoeas do not return before planning discharge.

When it stops

Apnoea of prematurity resolves as the brainstem matures, and for most babies that means it has settled by around 34 to 37 weeks corrected. Babies born extremely early may take longer, occasionally past their due date. It is not unusual for a baby to be off caffeine, apnoea-free for days, and then have one episode — the clock on the discharge plan restarts and it is maddening, but it is a safety margin rather than a setback.

Periodic breathing is not apnoea

There is a normal newborn pattern that looks alarming and is not. Periodic breathing is a run of fast breaths followed by a pause of a few seconds, repeating in cycles, without the heart rate dropping and without a fall in oxygen saturation. It is commoner in preterm babies and it can carry on for weeks after discharge.

The distinction that matters is what the pause does to your baby. Periodic breathing leaves colour, tone and heart rate unchanged. An apnoea that matters is accompanied by a slow heart rate, a colour change, or a baby who goes floppy. If you see the second version at home, that is a same-day call — and if it is prolonged, or your baby does not respond to you, that is an emergency call. Ask the unit to describe the difference to you before discharge, using your own baby as the example.

Desaturations during feeds

A specific version parents notice a lot: your baby drops their saturations while feeding at the breast or bottle. This is a coordination problem, not an apnoea problem. Sucking, swallowing and breathing have to take turns, and until that sequencing matures a baby can forget to breathe mid-feed. The answers are positional and paced — side-lying, external pacing, breaks — and the speech and language therapist or infant feeding specialist on the unit is the person to ask.

Home monitors

Almost every parent leaving a unit wants to take the monitor home, and the commercial market knows it. Consumer sock and mat monitors that claim to track a baby's oxygen or breathing are not medical devices, are not recommended by paediatric bodies for healthy babies at home, and have never been shown to prevent sudden infant death. The NHS guidance on reducing SIDS risk does not include buying a monitor; it centres on sleep position, a clear flat firm sleep surface, room-sharing, temperature and smoke-free environments.

A small number of babies are discharged with a genuine medical monitor, usually alongside home oxygen or a specific diagnosis. That is a prescribed piece of equipment with training and a support line attached, and it is not the same object as the one sold online. If you feel you need a monitor to sleep, say so to the discharge team — that is usually a sign you need more rooming-in, not more hardware.