Apnea in preemies

Apnea is forgetting to breathe and sounds incredibly scary, breathing is what keeps you alive and if you stop, well then you are not alive. The goal when a preemie forgets to breathe is of course to “remind” them by first hoping they will “remember” (resume breathing) on their own but if they don’t, you have to intervene. You pick them up, gently shake them (no shaken baby syndrome here, because we all know; you should never ever ever shake your baby), pat their back rather forcefully and stimulate their extremities (meaning rubbing their arms and legs) and tapping their feet. If they don’t resume breathing right away after this, oxygen masks are needed and of course if you are home with the baby you need to start CPR and call 911 right away (how horrifying is this?). In the NICU, they have the monitors on the babies at all times of course and it may seem like the nurses ignore almost every alarm but it’s not because they are oblivious or trying to let your baby die, I quickly learn, it’s because once an alarm goes off the babies regulate their own breathing soon after in most cases. It’s when they don’t and the nurses need to intervene that they call it apnea, an apnea attack, true or strong apnea and this goes down in the reports as an “episode” or if the heart slows down to a dangerously low rate, “an event”. The real diagnosis is called “Apnea of Prematurity” (AOP) and is quite common in premature babies (especially babies born before week 36). Apnea means that these babies have immature lungs and the part of the central nervous system controlling breathing is not mature enough to let them continuously breathe on their own. Preemies with apnea don’t get enough oxygen because they can’t continuously breathe, instead they breathe heavily, audibly and rapidly for a while, followed by very shallow breathing and sometimes they stop breathing all together. In the NICU, the monitors check on the baby’s oxygen level and intake and the baby’s breathing and heart rate. They also monitor the baby’s ability to regulate his or her body temperature and keep an eye on jaundice. Our baby has been under heat lamps for body temperature regulation and is also being treated for jaundice. She is getting antibiotics in her IV and they continuously check her blood.

Apnea is diagnosed when baby has an episode of stopped breathing after birth and medical professional usually define the condition as stopped breathing for 15 to 20 seconds. When baby’s heart rate drops below 80 beats per minute after he or she stops breathing, they become blue and pale, this event is called bradycardia or a “brady”. Apnea and bradys are carefully monitored in the NICU at the hospital where we are. When baby’s monitor indicates that his or her heart rate falls below 80, an alarm will sound. More often than not, the babies will resume breathing on their own and their hear rate will go back up. This is why it might seem like the nurses ignore most alarms which might frighten, worry and frustrate new moms of preemies (or send them into a panic frenzy…). You learn after a while that you can help your baby by picking them up, sitting them upright with a straight spine and patting their back and when heart rate goes up gently massaging their back in circular motions until the baby (and you) resumes breathing normally. Knowing what to do does not completely take away the panic you feel when nobody comes running to “fix” your baby when the alarm shrieks, especially if the heart rate does not go up right away on the monitor, but it might ease your worries slightly and it does get better with time. Better but far from good, when that alarm attached to your baby sounds, I don’t care who you are, you get scared. This night after the phone call from the NICU about my baby’s apnea episode, I feel utterly powerless and yes, scared. I thought she was okay, I thought she was doing fine. I thought they all joked about how good she was doing and her “not knowing” she was a preemie and that I had miscalculated her due date because she was so big and healthy looking. When why did she stop breathing, unable to resume breathing on her own without intervention? As I rush towards the big metal hospital elevators to try to get to my baby girl (even though there is little I can do to actually help her) a nurse comes running after me. She tells me that I am still not allowed to go down to the NICU under any circumstances. Why?…

 

 

 

 

About jennym

A doctor of psychology and a mother of three writing about the struggles and joys and the ups and downs of motherhood, marriage, pregnancies, deliveries and her absolute love for her children in a humoristic yet down to earth weekly blog!

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