Apnea in Newborn Babies – Things You Need to Understand

Newborn babies who are sleeping calmly are an angelic sight to most people. But to some parents, this holds slight anxiety especially when the worries of Sudden Infant Death Syndrome (SIDS) haunt you in between. So, when your baby pauses from breathing during sleep, your heart will also skip a beat. Sleep apnea is a thing not just for adults but also for newborn children. Is this normal, or should you panic?

Pediatric sleep apnea is a breathing disorder that happens to a newborn during sleep or nap. It is manifested by a pause in breathing that may last at about 20 seconds. According to Dr. Zarmina Ehsan of Children’s Mercy Sleep Center, about one to five percent of children experience this sleep disturbance. Sleep apnea is a normal developmental process. Some babies will eventually outgrow it, but severe apnea needs treatment to prevent future complications.

Are Sleep Apnea and SIDS the same?

Most people often associate sleep apnea with crib death or SIDS. However, bear in mind that these two are unrelated. The causes of SIDS still baffle experts up to this day. It happens when a full term and healthy baby suddenly dies in his sleep. There are preventive measures but no treatment yet so far.

Sleep apnea, on the other hand, has precursors to tell parents that the baby is experiencing it. The cessation of breathing is one. And, while newborns can get fussy and colicky, they never snore. If you happen to observe your newborn with persistent snoring or noisy breathing, it’s more likely that he has sleep troubles. We say persistent snoring because some infants may exhibit some very rare snoring when they are disturbed.

Sleep Apnea in Newborn – An Overview

For the first few weeks, newborn babies would alternate between sleeping and waking. Normally, they would experience breathing instability. One reason is that they still have an immature brain stem. Hence, as their bodies develop, they would experience this harmless pause in between breaths.

Babies with underlying medical conditions are also prone to sleep apnea. According to Mayo Clinic, infants with Down syndrome, cerebral palsy, sickle cell, or other neuromuscular diseases, are at higher risk. Apnea of Prematurity (AOP) also happens in premature infants and can go away after a couple of weeks. Preterm infants are likely to spend a few days with the NICU staff for monitoring.

Three Types of Apnea and Their Causes

Three Types of Apnea and Their Causes
  • Obstructive Sleep Apnea (OSA). This is characterized by nasal obstruction. It happens when there is a narrow opening from the baby’s upper airway or nose up to his lungs.
  • Central Sleep Apnea (CSA). CSA occurs when the baby’s brain experiences a delay in sending him a signal to breathe. This can happen even to healthy and full-term infants. Few CSA cases are considered normal which may be associated with a genetic disorder.
  • Mixed Apnea happens when a child experiences a central sleep apnea that is subsequently followed by an obstructive apnea. This is a common experience for pre-term babies.

Complications of Sleep Apnea

Sleep apnea occurs mostly during the Rapid Eye Movement stage in sleep. A partial pause in breathing is referred to as hypopnea. Apnea is the term for complete breathing pause.

When apnea happens, there is also a reduction in oxygen supply in the brain and blood. This incident is called hypoxemia or hypoxia. Hypoxemia happens when there is low oxygen in the blood. On the other hand, hypoxia occurs when there is low oxygen in the tissues.

Some people may use these terms interchangeably. Either way, this oxygen deprivation will result in organ damage, heart problems, growth problems, or even death.

Newborn’s Normal Breathing 

If you are watching your little ones, I bet there are times you are timing his breath with a clock. Some mommies may even rest their hands on their newborns to monitor the heaving under the swaddle. And if it skips a beat, or rush a pace, you start having a mini attack. 

Newborns breathe at about 30 to 60 breaths per minute. When asleep, this can lower down to about 20. It is completely normal if a newborn skips his breath for no more than 20 seconds. It is a developmental process that they will just outgrow no sooner.

Normal Heart Rate

Newborn babies naturally have a high heart or pulse rate. The normal range is between 107 to 181 beats per minute. It may climb up when they are crying, and drops when resting or sleeping. Resting heartbeat of newborns usually plays at 143 beats per minute.

All inherent human processes and adjustments happen to the child starting from day one of birth. Their physiological processes begin; they adjust to the world around them. They grow little by little every day until they are out of your house before you even realize it. So, it’s apt never to compare their body processes to that of an adult.

Symptoms of Apnea in Infants

A drop in your baby’s heart rate is normal especially during rest and sleep. But when a newborn registers a heartbeat lesser than 50 beats per minute, you need to inform your healthcare provider. In isolated cases, this may be a precursor of a heart problem called bradycardia. An apnea monitor is a useful tool for tracking a baby’s heart rate or breathing while at home. 

We can tell you not to worry, but we know it’s completely inevitable for you. This is especially true when you notice changes slightly different from the usual.

So, when should you take concern about your baby’s breathing during sleep and apneic episodes?  

  • If he is breathing with wheezing noise
  • Coughing
  • High-pitched whistling sound
  • Snoring
  • Choking
  • Grunting after each breath

Babies, especially preemie grunts, are usually harmless. It is sometimes an indication that your baby is in distress. Read why preemies grunt so much to tell the difference. 

Acid Reflux and Sleep Apnea

If a baby has acid reflux, he is likely to choke or refuse to feed at all. When the reflux of acid gets back to his mouth, it may cause him to hold his breath. And yes, it influences sleep quality and contributes to sleep apnea.

If your baby’s reflux is getting into his eating and sleeping, you may need to talk this out with his pediatrician. You should also schedule his sleep time at about 30 minutes after feeding and burp him before sleeping.

Raising your baby’s head in the bassinet may also help. But remember not to prop any pillow or anything on his bed to prevent suffocation and strangling. Ideally, you can put a firm pillow underneath the mattress to slightly elevate it.

Sleep Apnea Treatment for Newborn

Sleep Apnea Treatment for Newborn

Newborn sleep apnea will go away on its own as the baby grows older. But if it doesn’t slow down, or get worse over time, it needs to be considered for treatment. Untreated severe apnea will affect your child’s sleep foundation, his daily functioning, and even his body functions.

Infants with OSA are treated by giving oxygen and breathing support. Doctors may also recommend him to wear a Continuous Positive Airway Pressure (CPAP). It is a mask that is attached to a pump to supply him with air while sleeping. The baby will also be treated for acid reflux or allergies to manage his respiratory effort.  

What should you do if a newborn stops breathing?

It does happen in isolated cases. We put our trust this will not happen to you, but what should you do if you find a newborn that stops breathing?

Here’s how from the Red Cross team:

  1. Check for breathing by tilting a baby’s head back while you feel for breath. Tilting his head will open the airways since his tongue would pull back.
  2. If he is breathing yet unresponsive, hold him to the side while still tilting his head. It will drain any fluid that may be obstructing his airways.
  3. Cradle the baby in this manner and dial emergency. If you should put him down for the call, lay him on his side.

If the baby seems to be not breathing when you tilt his head back, have someone call emergency and give rescue breaths and chest compression.

  1. Tilt his head back and seal both his mouth and nose with your mouth.
  2. Blow five times into the baby.
  3. Lie the baby down and put two fingers over the middle of his chest. Push firmly thirty times.
  4. Give two rescue breaths.
  5. Do thirty chest compressions again. Do these cycles until help arrives.

Conclusion

Newborn babies experience sleep apnea for various reasons. As they grow up and begin to develop their body functions, it may go away on its own. But if the child suffers extreme sleep apnea that goes in the way of his normal body processes, he may need to undergo treatment.

If your baby is gasping for breath, choking in his sleep, or snorting, talk this out with his doctor. He will help rule out any problem with your newborn earlier if there is any. It is okay to be panicky and a worrier, but do not assume it with ungrounded fears. Your doctor will be there to assure you, reassure you, or give medical recommendations if needed.  

Ann Marie is a licensed nurse in the Philippines. She experienced handling and assisting deliveries of newborns into the world. She also trained in labor rooms and pediatric wards while in nursing school - helping soon-to-be mothers and little kids in the process. Though not a mother by nature but a mother by heart, Ann Marie loves to take care of her younger cousins as well as nephews and nieces during her free time.

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