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Apnea of Prematurity
AOP

Presentation

Malformations of the brain or less likely, the spinal cord, should be considered in an otherwise healthy infant who presents with apnea at birth. [doi.org]

Both included studies were randomized double-blind placebo control prevention trials among babies CONCLUSION: Present evidence does not support the regular use of carnitine for the prevention of apnea of prematurity. [ncbi.nlm.nih.gov]

Urogenital

  • Polyuria

    Although caffeine is generally a well tolerated agent, signs of overdose, severe tachyarrhythmia, irritability, jaundice, food intolerance, and polyuria, must be recognized. [dovepress.com]

Neurologic

  • Quadriplegia

    […] longer than the age of term gestation are often very premature (24-28 weeks’ gestation) and/or have known neurologic dysfunction. 11,12 Complications Consequences of untreated or inadequately treated AOP are extensive and include spastic diplegia or quadriplegia [uspharmacist.com]

Workup

X-Ray

  • Subglottic Narrowing

    Direct laryngoscopy to assess the vocal cords and subglottic area and to look for the presence of laryngomalacia and whether there is edema around the vocal cords suggesting GER, or subglottic narrowing in an infant who was previously intubated. [clinicaladvisor.com]

Urine

  • Bilirubin Increased

    We hypothesized that in this population, as bilirubin increases and causes auditory brainstem dysfunction, respiratory control system may also be adversely affected leading to increased frequency of AoP. [ncbi.nlm.nih.gov]

QT, RR, ST Intervals

  • Prolonged QT Interval

    QT interval [ 36, 43 ] and hypokalemia [ 21 ]. [karger.com]

Treatment

All causes of secondary apnea must be ruled out before initiating treatment for AOP. Treatment will depend on the etiology as well as effectiveness and tolerability of the treatment by the patient. [ncbi.nlm.nih.gov]

Prognosis

[…] metabolism* Hypoxia/complications Hypoxia/metabolism* Infant, Newborn Infant, Premature/metabolism Infant, Premature, Diseases*/etiology Infant, Premature, Diseases*/metabolism Infant, Premature, Diseases*/physiopathology Infant, Premature, Diseases*/therapy Prognosis [ncbi.nlm.nih.gov]

Prognosis is excellent; apnea resolves in most premature neonates by 37 weeks postmenstrual age and in almost all premature infants by 44 weeks postmenstrual age. [merckmanuals.com]

Because the prognosis is excellent and because the infant is not compromised, no treatment is usually required. [emedicine.com]

Etiology

Publication type, MeSH terms, Substances Publication type Review MeSH terms Apnea*/etiology Apnea*/metabolism Apnea*/physiopathology Apnea*/therapy Arrhythmias, Cardiac/chemically induced Brain Stem/drug effects Brain Stem/growth & development Caffeine [ncbi.nlm.nih.gov]

Its etiology is often multi factorial and diagnosis of idiopathic forms requires exclusion of other underlying diseases. [jpnim.com]

Epidemiology

The definition and classification of apnea are discussed, as well as its epidemiology and natural history. [ncbi.nlm.nih.gov]

The purpose of this clinical report is to review the evidence basis for the defi nition, epidemiology, and treatment of apnea of prematurity as well as discharge recommendations for preterm infants diagnosed with recurrent apneic events. [jhu.pure.elsevier.com]

Although infants born preterm have a higher risk of SIDS, epidemiologic and physiologic data do not support a causal link with apnea of prematurity. [pediatrics.aappublications.org]

Pathophysiology

The pathophysiology of apnea is considered in detail, including the chemosensory and reflex input that modulates respiration and the involvement of upper airway control in the etiology of obstructive apnea. [ncbi.nlm.nih.gov]

"Pathophysiologic Mechanisms Underlying Apnea of Prematurity". NeoReviews. 3 (4): e59–e65. doi : 10.1542/neo.3-4-e59. ^ Baird, T.M.; et al. (2002). "Clinical Associations, Treatment, and Outcome of Apnea of Prematurity". [en.wikipedia.org]

Prevention

Both included studies were randomized double-blind placebo control prevention trials among babies CONCLUSION: Present evidence does not support the regular use of carnitine for the prevention of apnea of prematurity. [ncbi.nlm.nih.gov]

Therefore, choosing an intervention which can prevent and reduce occurrence of AOP with fewer side effects is an important issue that should be closely watched by neonatal intensive care unit (NICU) health care. [clinicaltrials.gov]

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