Central Apnea during sleeping in Term Newborn during neonatal period

[Pototo]

Do you have any protocol or bibliografy?¿?

tanks a lot 

[piatkat]

Hi, no protocol from me as I'm not working clinically right now, but in clinical research with actually a focus on apnea!

As a very research-oriented person my first question is- how do you know it is a central apnea? If you are sure it is central, and it happens only during sleep- this is super interesting-- read here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6900881/)

Infants born at term still go trough maturation of their central nervous system, and that also includes maturation of the breathing pattern. They might present periodic breathing and short apnea, but their ability to cope with the heart rate and saturation control is much better, therefore they might be less vulnerable to apnea events and their consequences.

I would definitely consider potential causes, depending on the time of presentation of apnea (perinatal injury? infection? metabolic disease? cns anomalies? medications? and of course rare but exists: central hypoventilation syndrome). 

In this paper from 2017 (Patrinos ME, Martin RJ. Apnea in the term infant. Semin Fetal Neonatal Med. 2017, see attached) they describe BRUE (brief resolved unexplained event): A BRUE is an event occurring in infants <1 year of age with one or more of the following: (i) cyanosis or pallor; (ii) absent, decreased, or irregular breathing; (iii) marked change in tone (hyper- or hypotonia); and (iv) altered level of responsiveness. The diagnosis of BRUE should only be applied when there is no explanation for a qualifying event after a thorough history and physical examination.

Box 2 Serious conditions presenting with BRUE (brief resolved unexplained event)-like symptoms: 

• Gastroesophageal reflux
• Respiratory tract infection [respiratory syncytial virus]
• Seizure or central nervous system disorder
• Child abuse
• Other (Poisoning, Bilirubin encephalopathy, Cardiac disease, Structural Conduction or ion channel (channelopathies) defects, Cardiomyopathies, Arrhythmias, Metabolic disorders/inborn errors of metabolism, Anaphylaxis, Bacterial infections (including urinary tract infection), Upper airway obstruction/obstructive sleep apnea, Anemia)

When it comes to the evaluation and management of such infant, authors of that paper recommend laboratory tests including glucose levels, electrolytes, calcium, a complete blood count, and blood gas analyses. It's advisable for the infant to be monitored in a NICU with cardiorespiratory and pulse oximetry observation. Depending on the history, consider neuroimaging, an electroencephalogram, ENT consult, and a genetics assessment.

So yadda yadda yadda, hopefully some clinicians here will say something more straightforward, but yeah I think you need to think about everything, but lets keep in mind that even term infants can have some (central) apnea.

1-s2.0-S1744165X17300446-main (1).pdf

[Pototo]

Thanks a lot. 

He is a term newborn, with diagnosis : Central sleep apnea syndrom ( in not preterm infant).  Polysomnography: confirming the daignosis of severe central SAS.

We start oral  cafein.  

[ckg]

Treatment depends on the cause of the apnoea .For example in Seizures apnea anticonvulsant and invasive or noninvasive ventilation .

Apnea of Prematurity requires arousal, caffeine, aminophyllin , CPAP .

[Gustaf Lernfelt]

Dear Pototo,

What work up have you done, and how did the case present itself?

[piatkat]

There's one paper that I'm aware of  Hayashi A, Suresh S, Kevat A, Robinson J, Kapur N. Central sleep apnea in otherwise healthy term infants. J Clin Sleep Med. 2022  describing application of oxygen supplementation as a treatment for central sleep apnea in a population of term infants with central sleep apnea, with normal neuro and cardiac imaging. They were able to wean off these infants in majority within the first year of life. They discuss that supplemental oxygen abolishes periodic breathing and reduces frequency of apnea episodes in these infants. IMHO worth reading

 

hayashi-et-al-2022-central-sleep-apnea-in-otherwise-healthy-term-infants.pdf

[Pototo]

Thanks a lot,  piatkat. That is perfect.  This   was  what i was looking for. 

[AntoineBachy]

Any sign of dysautonomia (temp control, Heart rate, ...) or hirschprung ?

Hypercapnia?

Would consider Ondine syndrome in DDx

 

Bookshelf_NBK1427.pdf

[Pototo]

Genetic test: ok  Thanks

The patient discharge at home.