It is normal for all babies (and adults too) to have gaps or pauses between breaths. Normal breathing for babies usually involves a gap of between 5-10 seconds between breaths. This is called periodic breathing.
If your baby has gap between a breath that is longer, say of 10-20 seconds, then this is called an apnoea. This pause in breathing can have a knock-on effect with heart rate and oxygen levels in the blood.
Your baby’s heart will normally beat at around 100 beats per minute (premature baby rate). A slowing of this rate is called a bradycardia. Often there is a link between an apnoea and a bradycardia because as breathing slows the heart rate also slows. Staff often refer to a bradycardia as a “braddy” .
Whilst some babies have “braddies” without any apnoea they are usually linked and the two conditions are often lumped together and referred to equally. A common term for apnoea with bradycardia is “As and Bs.”
In most babies the rate of oxygen in the blood is around 92-96%. Desaturation is a decrease in the percentage of oxygen found in the circulating blood supply. In premature babies a saturation below 85 is considered below normal. Desaturation is often the result of bradycardia.
Bradycardia will often follow apnoea, a period of rapid shallow breathing, insertion of a feeding tube, or an attempted bowel movement.
Occasionally apnoea and bradycardia can also be caused (or increased in frequency) by other issues, such as infection, low blood sugar, patent ductus arteriosus (PDA), high or low body temperature, insufficient oxygen, etc. Bradycardia may also be caused by acid reflux. Medical staff will examine each baby to determine whether any of these issues are relevant to him/her.
Apnoeas and bradycardia are usually caused by the immaturity of your baby’s nervous system. Put simply the bit of your baby’s brain that prompt him or her to breathe “forgets”. He or she may pause or have a few very shallow breaths followed a big breath. If your baby was still in the womb his or her lungs and airways would not have to be working.
If your baby is going to be affected these episodes they usually start quite quickly after birth, usually within a day or two. As your baby grows and matures these tend to disappear.
If your baby is having help breathing from a ventilator apnoeas will only become apparent once your baby has to breath on his or her own.
Most premature babies experience these episodes. The earlier your baby is the more likely he or she is to have them.
Staff carefully monitor babies in NICU and will be vigilant for breathing issues. If your baby does have an episode you may find his or her skin appearance will change during such an episode. Skin will become pale and blue-ish purply and patchy. Afro-Caribbean babies tend to have darker lips and a darker area around their nose and tongues.
In most NICU’s babies are attached to an apnoea monitor which will alarm if the pause or gap in your baby’s breaths are too long.
Your baby may also be attached to a pulse oximeter that measures the amount of oxygen in the blood and be attached to a cardio respiratory monitor to keep a check on heartbeat and breathing rate. Both will alarm to let staff know if your baby is having and apnoea or bradycardia.
Following a pause in breath usually babies start breathing again of their own accord. If the gap or pause between breaths is more than 20 seconds (and usually an apnoea alarm will draw staff’s attention to this episode) just a gentle stroke or rubbing of a foot is enough to help your baby start breathing again.
If the stroking is not effective sometimes a member of staff will waft some oxygen near your baby’s face. Sometimes it is necessary to “bag” your baby. This means an oxygen mask is placed over your baby’s mouth and nose and oxygen is pumped into your baby’s lungs.
If your baby has experienced episodes of difficulty in breathing staff will tell you about this. They are also recorded in your baby’s records. Staff will also keep an extra special eye on a baby that is experiencing frequent episodes as it may be a sign of some other underlying problem, particularly if they suddenly become more frequent.
Your baby might be given some physical assistance with breathing in the form of CPAP (see Guide to Terms) or medicine to stimulate the nervous system, often a caffeine type medicine.
Most babies have sorted out their breathing by 34 weeks or so gestation.
If your baby is having apnoeas it can be really frightening. Many parents comment on how distressing all the alarms can be. Staff often remind parents to concentrate on the baby and not on the machines-easier said than done! If you watch a member of staff approach a baby when an alarm has gone off whilst they will glimpse at the monitors etc the main focus will be on how your baby looks. They will assess their skin colour and generally how comfortable and well you baby looks.
Our aim in preparing this sheet is to provide parent-friendly information that is easy to understand. This information sheet has been prepared by a parent of a premature baby who does not have any medical background or qualifications. Please do not rely on it. You should always seek the advice of a doctor or medical staff and talk to them about any questions or concerns you have about your baby.
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