Apnea of prematurity is diagnosed based on clinical grounds in premature neonates after systemic and pulmonary causes of apnea have been excluded. Auditory brainstem evoked responses are delayed in a large number of premature neonates with apnea. A brainstem conduction showing a III to V interpeak latency below 5.6 milliseconds usually coincides with resolution of apnea in neonates.Treatment of apnea of prematurity includes stimulation, pharmacologic intervention (caffeine or theophylline), continuous positive airway pressure, and mechanical ventilation. The usual loading dose of caffeine citrate is 20 mg/kg followed by a maintenance dose of 5 mg/kg per day beginning 24 hours after the loading dose. The usual loading dose of theophylline is 5 mg/kg followed by 1.5 to 2 mg/kg every 8 hours.
Congenital hypoventilation syndrome produces hypoxemia, especially during quiet sleep, even in the absence of apnea. Apnea is central and occurs predominantly during quiet sleep. Congenital central hypoventilation syndrome is a diagnosis of exclusion. Congenital hypoventilation syndrome may be associated with Hirshprung disease and Rett syndrome. More about...81 . The diagnosis is supported by the presence of sustained hypoxia during quiet sleep. Central hypoventilation syndrome may improve with doxapram but tracheostomy with mechanical ventilation or a diaphragmatic pacemaker are usually required.
Apnea in startle disease (hyperekplexia) occurs during spontaneous or provoked episodes of generalized stiffening. Episodes of stiffening may be provoked by noise or touch. Tapping the nose is particularly likely to produce an apneic episode in neonates with startle disease. Apnea in neonates with startle disease stops with forced flexion of the neck and legs towards the trunk.
Feeding apnea is diagnosed clinically. Feeding apnea may be central, obstructive, or mixed. It occurs during feeding in preterm and term neonates and is controlled by frequent interruption during feeding. Feeding apnea is probably due to lack of coordination between breathing and swallowing mechanisms in the brainstem.