Observation on neonatal apnea in relation to aetiopathogensis and their outcome
Keywords:Apnea, Apnea of prematurity, Neonatal sepsis, Low birth weight, Preterm
Background: Apnea is nearly universal among preterm infants, but neither the apnea burden nor its clinical associations have been systematically studied. This study was aimed to estimate the frequency of apnea in newborn, at different gestational age and birth weight and establish different etiological factors of apnea in newborn and their outcome.
Methods: The present study was conducted on neonates admitted in Special Newborn Care Unit, Department of Pediatrics, MGM Medical College and LSK Hospital, Kishanganj, Bihar, India between April, 2014 to September, 2016. All neonates at risk of apnea (< 34 weeks gestation) were monitored for at least the first week of life. Only neonates who developed apnea were included in this study.
Results: Out of 1275 newborns admitted in special newborn care unit, 637 were preterm and 98 newborns were diagnosed as having apnea- 96 were preterm and 2 were term. The frequency of apnea in babies ≤ 30 weeks was 45.91 per 100 live births. It gradually decreased to 13.45, 5.30 and 0.31 per 100 live births in newborn aged 31-32 weeks, 33-36 weeks and ≥37 weeks respectively( statistically significant, p value < 0.001). The frequency of apnea in babies whose weight was less than 1000 gm, between 1000-1499 gm, 1500-2499 gm and > 2500 gm was 38.88, 15.09, 6.45 and 0.49 per 100 live births respectively (statistically significant, p value < 0.001). In our study commonest causes of apnea was infection (51.02%) and apnea of prematurity (29.59%) (Statistically significant, p value < 0.001). The mean birth weight and gestation were 1434.34gm and 31.6 weeks for the infection group and 1117.41gm and 30.34 weeks for the apnea of prematurity group in our study. The survival rate in babies with apnea of prematurity was 72.41% (p <0.001) as compared to 32% (P <0.001) in apnea due to infection group. The percentage of survival in < 1000 gm, 1000-1499 gm, 1500-2499 gm and 2500gm was 22.85,55,60 and 100 percent respectively (p value < 0.001).
Conclusions: Infection and apnea of prematurity are common causes of apnea in newborn. All babies ≤ 32 weeks gestation needs to be closely monitored for apnea. Apneic spells occurring in infants at or near term are always abnormal and are nearly always associated with serious causes. Apnea due to sepsis carries a poor prognosis.
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