Apnoea of Prematurity (AOP)
AOP is a diagnosis of exclusion in preterm infants, characterized by a cessation of breathing for >20 seconds, or shorter pauses associated with bradycardia (<100 bpm) or oxygen desaturation.
1. Pathophysiology & Diagnosis
- Mechanism: Immaturity of the respiratory control centers in the brainstem (medulla) and decreased peripheral chemoreceptor sensitivity.
- Exclusion is Key: Before diagnosing AOP, always rule out:
- Sepsis (the #1 differential)
- Necrotizing Enterocolitis (NEC)
- Metabolic disturbances (hypoglycemia, hypocalcemia)
- Anemia or intracranial hemorrhage
2. Management Strategies
| Intervention | Objective |
|---|---|
| Gentle Stimulation | First-line physical intervention for self-limiting episodes. |
| Methylxanthines | Caffeine Citrate (preferred over theophylline) stimulates the respiratory center. |
| Respiratory Support | Nasal CPAP if pharmacotherapy fails. |
3. High-Yield Clinical Pearls
- Caffeine Dosage: Caffeine citrate is standard because of its wider therapeutic index and once-daily dosing compared to theophylline.
- Resolution: AOP usually resolves by 36–40 weeks post-menstrual age as the infant matures.
NEET PG Hint: Remember: Sepsis is the most common cause of pathological apnea in a neonate. Never attribute apnea to “prematurity” without excluding infection first. For more high-yield neonatology and free medical questions, visit mymedschool.org.