APNEA

Definition:
Apnea - Cessation of respiration >20 seconds (preterm) associated with bradicardia (<100/minute) or cyanosis (SpO2 <80%). Periodic breathing - Regular sequence of respiratory pauses of 10-20seconds interspersed with periods of yperventilation (4 5 second) and occurring at least 3 times/minutes, not associated with cyanosis or bradycardia.

Types Of Apnea:
Central apnea - Definition:A total absence of airflow and respiratory effort. Obstructive apnea - Definition: absence of airflow with continued respiratory effort, associated with blockage of airway at the level of pharynx and or larynx. Mixed apnea - Definition: a combination of central and obstructive apnea, obstruction usually at the level of the pharynx. 50% of all apnea is mixed apnea

Causes Of Apnea:
1. Primary - Prematurity

apnea of prematurity

2.

Secondary - Hypoxia - Respiratory disorder: RDS Airway obstruction Pneumothorax Aspiration Atelectasis

Causes Of Apnea:
Secondary :

(conti..)

Central nervous system disorder: Asphyxia IVH Seizures Infection: Sepsis Pneumonia NEC Meningitis

Causes Of Apnea:
PDA
Anaemia

(conti..)

Metabolic: Hypoglycaemia Hypocalcemia Acidosis

Gastroesophageal reflux Drug abuse

Causes Of Apnea:
3. Precipitating Factors

(conti..)

Environmental conditions Rapid warming Elevated environmental temperature Hypothermia Hyperthermia Positioning Feeding Stooling Painful stimuli

Manifestasi klinikal apnea:

1. Cyanosis:
Due to increasing hypoxemia Low O2 saturation in the blood

2. Periodic breathing:
Pause in respiration lasting 5-10 second

Manifestasi klinikal apnea:

(CONT..)

4. Flaccid
Weakness or decreased muscle tone

5. Low blood pressure Decreased cardiac output. 7. Bradycardia Decreased cardiac contractility

PATHOGENESIS OF APNEA
Immature CNS Gangguan dalam pengembangan paru-paru Gangguan pertukaran gas O2 CaO2 Hypoxia cell & Depressed respiration centre Lactic acid
Anaerobik metabolism

Metabolic Acidosis

Gangguan dalam kontraktiliti myocardium

bradiacardia > 20 sec

Apnea (Brady/cyanosis/hypotonia)

Nursing management during apneic

1. Asses baby: evaluates respirations, heart rate
below 100bpm and color Apnea or gasping respirations

2. Reposition: baby with neck slightly extended (sniffing position) to maintain airway paten
3. Suction to: oropharynx, then nasopharynx if vomiting observed to prevent aspirate.- to clear airway

4. Reevaluate: again if baby no respon

Nursing management during apneic (conti..)

5. Stimulate the baby by - slapping or flicking the soles of the feet - gentle rubbing the back.

6. If baby respond to tactile stimulation: evaluate respiration, heart rate >100 give supplemental oksigen and colour in 30 second
7. If not responding: to tactile stimulation and no spontaneous breathing and heart rate <100 provide Positive pressure ventilation 8. Summon help if infant does not respond 9. Asses baby again after 30 second and monitor the heart rate and breath sound

Nursing management during apneic

(conti..)

10. If heart rate <60bpm administer chest compressions and ventilation for 30 second 11. Check the heart rate Greater than 60bpm discontinue compressions and continue ventilation at 40 to 60 breath per minute. Greater than 100bpm discontinue compressions and gradually discontinue ventilation if the baby is breathing spontaneously. Less than 60bpm intubate the baby 12. Document and report: length of apneic time of apneic episode and any relation to feeding (before, during or after) sleep, procedure, activity or stooling.

Thank you.
by nurhaslinda mohd zulkifly