Apnea of Infancy


Dear Dr. Greene, If an infant has had a history of childhood apnea to the extent that he has had to use a heart and lung monitor during the sleeping hours for the first two years of his life, and now requires an operation involving general anesthesia, a) Would general anesthesia pose any danger? b) Have you ever heard of a similar case? Thank you.
Hamid Zandieh - Alicante, Spain

Dr. Greene's Answer

I’ll never forget the night my firstborn son came home from the hospital. Earlier that day, while in my arms in the labor and delivery suite, he had stopped breathing for what seemed like an eternity, but was probably about 20 seconds. His face had turned blue. Could it be apnea of infancy? I reported this to those taking care of him, who thought that I was just a nervous first-time parent who happened to also be a medical student with an over-active imagination. They examined him, found nothing wrong, and persuaded me to take him home without a machine to monitor his heart and lungs. They would check him again soon.

That night his mother, my mother, and I took turns hovering over the sleeping form of my precious son. Our nighttime vigil felt interminable. Each breath seemed so precarious — or had I really just imagined that he had turned blue?

Everything went well that night, with no further episodes. In the light of the next day, we brought my son to visit a friend — who was also a professor of pediatrics. While awake in his arms, it happened again. My son turned blue and stopped breathing. Suddenly, everyone was concerned. This led to a flurry of tests. My son was diagnosed with Apnea of Infancy, and went home with a heart and lung monitor, which he wore for nine months.

For a child to take a breath, he needs an open, unobstructed airway from the nose or mouth all the way down into the lungs. He needs properly functioning respiratory muscles. He also needs a signal to breathe, originating in the respiratory center of the brain, and accurately transmitted via nerves to the appropriate muscles. This signal to breathe may be a conscious choice, or may be an unconscious response to the sensors which measure the oxygen content, carbon dioxide content and pH of the blood.

Any part of this pathway may fail to work properly. Sometimes the system may work when a child is awake, but not when he is asleep.

Apnea of infancy is the cessation of breathing for longer than 15-20 seconds, or for any duration if it is accompanied by color changes or an abnormally slow heart rate. This respiratory pause can result from a host of different causes.

In central apnea, the brain’s control of breathing isn’t working. This can be the result of immaturity of the respiratory center of the brain, or of bleeding, drugs, seizures, brain injury, neuromuscular disorders or other problems. In obstructive apnea, the urge to breathe is present, but breathing is mechanically blocked. This can result from upper airway collapse, gastroesophageal reflux, vocal cord spasm, pneumonia, external pressure on the airway, and a long list of other causes.

Testing revealed my son’s apnea of infancy to be a combination of central and obstructive apnea. Rising levels of carbon dioxide in his blood failed to trigger him to take a breath, particularly when he was asleep. Sometimes, when he was awake, his vocal cords would close, blocking his airway. His large tonsils also partially blocked the airway. Eventually he outgrew these problems, and has been quite healthy ever since.

The treatment for apnea of infancy consists of correcting the underlying cause (if possible) or waiting for the child to grow out of it. In the meantime the child wears a sensor connected to an apnea monitor to alert the parents if there is another apnea spell. An alarm goes off if the breathing pauses, if the heart rate drops, if the heart rate is too high, if the sensor leads become disconnected, if there is a power failure, or if the back-up battery is running low. The parents are trained in cardiopulmonary resuscitation (CPR), to help the child resume breathing when a spell occurs.

Once my son was on a monitor, I was able to sleep.

For most children with apnea, the operating room is a safer place to be than almost anywhere else. The child’s breathing, heart rate, and oxygen saturation are continuously monitored. During the operation, adequate oxygen is delivered, and the signal for each breath comes from the ventilating machine. An open airway is ensured by an endotracheal tube. If something were to go wrong, the child is surrounded by the optimal people and equipment to reverse the problem.

The risk posed to your son by general anesthesia will depend on the underlying cause of his apnea. I urge you to discuss your son’s situation both with the anesthesiologist and with your regular doctor. With full information, they can help you weigh the risks and benefits of the operation, and provide the best care — whatever you decide.

Last medical review on: July 02, 2010
About the Author
Photo of Alan Greene MD
Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.
Get Dr. Greene's Wellness RecommendationsSignup now to get Dr. Greene's healing philosophy, insight into medical trends, parenting tips, seasonal highlights, and health news delivered to your inbox every month.
Add your comment

Recent Comments

How long could your son outgrow the apnea?

Hi my son is 11 weeks post birth today. He was born at 36 weeks and 6 days. We were set to go home from the hosptial and bcs of his 1 day shy of 37 weeks, they did a car seat trial with him which he failed and was sent to the NICU. There they reported he was having episodes of periodic breathing and bradycardias. Desats reported and apnea. They told me this is tyoical for boys and preemie babies but here we are 11 weeks later with a sleep study, a visit to cardiology and a visit to pulmonology and no answers. The sleep study showed he is having central and obstructive apneas. The bradys have stopped but the desats continue. He is home on a monitor and thry just put him on .5 liters of oxygen. He is scheduled for an MRI in 5 weeks. ENT couldnt rule anything out at this time. My question is…..what are the chances he could still outgrow this? My hope is nearly depleated and im desperate for a glimmer. Also, if the central apneas continue, is it treatable with meds?

at the point of desperation and more googling I came across this article on apnea in infancy and figured I would reach out in hopes of getting some advice. Very long story so I will be as brief and descriptive as possible and hope that maybe you could share your experience or offer some advice.
1 month ago my 12 week old buy suddenly turned blue while I was holding him in my arms. We called 911 and were rushed to children’s hospital where he had two more events there. He had been on Axid for his acid reflux since ~ 4 weeks old and after being examined they determined that it was the reflux that was causing these blue spells. they introduced a PPI to go along with the H2 blocker and we were discharged 48 hours later. All was going great but then 11 days later, he stopped breathing again and again we ended up at children’s. This time they did a throat scope and saw he had an issue with his epiglottis and performed a supraglottiplasty. again, he was fine for 3 or 4 days, they discharged us and again he stopped breathing! back to children’s where they hooked him up to an EEG. during this he had 9 more spells. Of these 9, the neuro team concluded that 6 of them showed some abnormal electrical activity. so my question has always been, what were the other 3? They can’t seem to figure it out and still are not 100% convinced he is having seizures. nonetheless they started him on Keppra two weeks ago today. He was fine on that for 2 days, then had 2 events spaced 24hrs apart. they decided to bump his keppra up and monitor him. He had no more episodes until this morning when he stopped breathing again. I called the neuro dr. and his solution is to split his keppa dose into 3 times per day. again I asked him if he was convinced we were treating the right thing and again he said he wasn’t completely sure! I should note that several nurses, doctors, an anesthesiologist, a lactation specialist all saw these events first hand and dispelled that they were seizures based on how he looked during them. he is always very calm, awake, alert, then just stops breathing. there is no jerking, clinching, etc.. except for when we stimulate him (which seams to be a common startle response in a baby) he is a happy, healthy, chubby, alert, playful little 3 month old now that has zero other symptoms of seizures. So, I am at a lose of what to think now. I don’t want to continue treating him with seizure meds if there is something else going on. I read your article and am curious how your doctors arrived at your diagnosis? any insight or advice would be greatly appreciated.

Did your son recurve Hep B vaccine?

How long was your son on the apnea monitor? Was he on any medications? Did he continue to have the blue spells while at home? My son is also having a combination of central and obstructive apnea. He is on a monitor. Can you give any other advice or suggestions. It is terrifying. Thank you.

How long could your son outgrow the apnea?