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Monday, January 31, 2011

RECURRENT NEONATAL APNEA (APNEIC SPELLS)

This condition is characterized by intermittent apnea ( sudden cessation of respiration0 followed by cyanosis, bradycardia and limpness with unresponsiveness to stimuli.


Etiopathogenesis
Predisposing conditions include low birth weight (under 1,500 g) and/ or gestation under 32 Weeks, HMD aspiration, pneumonia, pulmonary hemorrhage, congenital heart disease, birth trauma, maternal sedation, accidental injection of local anesthetic during labor, tracheoesophageal fistula, diaphragmatic hernia, choanal atresia, pierre robin syndrome, hyberbilirubinemia, hypoglycemia, acidosis, dehydration, septicemia and methemoglobinemia

Triggering factors include frequent handling environmental heat, vigorous suction, sudden flexion of neck, and lung inflation ( head paradoxical reflex).
The fundamental pathologic defect appears to be an immaturity of the medullary respiratory center which lacks effective respiratory drive.

Diagnosis
It is primarily clinical, such conditions as periodic breathing, cyanotic spells, convulsions, esophageal atresia, HMD, aspiration pneumonia, diaphragmatic hernia, and congenital heart disease should be considered in the differential diagnosis.

Treatment
If cutaneous stimulation and artificial respiration fail to initiate breathing, a respiratory stimulant, theophylline 5mg/kg(IV) followed every 8 hourly by 2 mg/kg (IV or O) may bring about gratifying response. Caffeine citrate (IV) is an equally good alternative.
Supportive measures include nursing in an incubator to maintain temperature at the lower end of the environment range, oxygen inhalation, IV drip of 10% glucose, correction of hypoglycemia, hypocalcemia, acidosis and antibiotic therapy when apneic attacks manifest after 3 days of birth.

Prognosis
Survivors, especially with immaturity , show high incidence of brain damage.

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