At the Bryan Infant Apnea Center, we provide services to infants and children who are at risk for respiratory, cardiac or sleep problems.
Under the medical direction of Dr. Akhtar Niazi, and in coordination with your primary doctor, the Infant Apnea Center provides evaluation; diagnostic testing, including multi-channel recordings, polysomnography and pH studies; and treatment when necessary. The Infant Apnea Center also coordinates home apnea monitor referrals.
Classes are taught by registered nurses and respiratory therapists. The staff provides comprehensive follow-up and home visits as needed until the apnea monitor is no longer needed. A social worker is available to assist families with psychosocial needs.
Dr. Niazi and the Infant Apnea Center staff welcome the chance to provide information and assistance regarding any infant or pediatric sleep disorder.
When the monitor alarm sounds, a nurse goes to the baby and observes. The nurse determines whether the baby is breathing, the baby's heart rate and whether the baby's skin has changed color. Many times a baby will start breathing again and does not need any help.
If a baby is not breathing, the back, arms or legs are rubbed. The baby's head may be turned to a different side or he/she may be turned over. This kind of stimulation is continued until the baby is clearly trying to breathe again. If a baby remains pale or bluish, oxygen maybe given. Occasionally a baby may be given some breaths with a bag filled with oxygen to help him/her start breathing again.
Several medications can stimulate the part of the brain that controls breathing and can reduce the number of apnea spells. Caffeine is the most commonly used drug and is given by IV or by mouth. Side effects from the medications are usually mild. They include fast heart rate, vomiting and irritability. The levels of medication in the blood can be measured and the dosage adjusted to get just the right level and avoid most side effects. A baby continues to receive medication until he/she has outgrown the apnea spells.
Because premature and sick newborn babies are likely to have apnea, all premature babies admitted to Bryan Neonatal Intensive Care will have a monitor attached to them that continuously measures heart rate and respiratory (breathing) rate. If a baby stops breathing for too long or his/her heart rate drops too low, the monitor sounds an alarm to alert the staff. A nurse then immediately checks the baby for distress.
Many alarms are false because the monitor did not measure the breathing or heart rate correctly. Sometimes the monitor leads come off the skin, causing an alarm to sound. Someone must check the baby each time the alarm sounds. Alarms are recorded to track how a baby is doing.
Home Apnea Monitoring
What is a Home Apnea Monitor?
A home apnea monitor is a portable device that monitors a baby's breathing and heart rate. If heart rate or breathing should slow below the limits set, an alarm will sound, calling the parents to check the baby immediately.
We use apnea monitors with memory capability. Heart rate and respirations are recorded during each alarm to help differentiate true events and false alarms that can occur due to motion or poor signal. This information is downloaded monthly (or more often if needed). The stored data from the memory monitor is evaluated by Dr. Niazi who will provide recommendations as to when it is safe to stop the monitor.
Who Should be Evaluated for Home Monitoring?
- Premature infants who continue to have apnea and bradycardia alarms as hospital discharge date nears
- Symptomatic Infants – Those infants who experience an acute life threatening event (ALTE), characterized by the cessation of breathing, color change or change in state of consciousness
- Infants of substance abusing mothers who may be at increased risk for SIDS
- Infants with congenital abnormalities that may affect breathing
- Infants with tracheostomy, home oxygen or medical conditions that put them at risk for central and obstructive apnea
Apnea simply means "without breath". Apnea is not always abnormal. For instance, between every breath we take is a period of apnea. Some periods are longer than others.
It can be normal for a newborn baby to have periods of apnea from 10-15 seconds. Newborn breathing can be very irregular and still be considered normal.
The American Academy of Pediatrics defines prolonged apnea as "cessation of breathing for 20 seconds or longer, or a briefer episode associated with bradycardia, cyanosis or pallor". In layman's terms, it means that breathing has stopped for more than 20 seconds, or a period of apnea of any length is accompanied by a change in color, a slowing of the heart rate or unresponsiveness.
Bradycardia is a slowing of the heart rate, usually less than 80 beats per minute for a premature infant. Bradycardia often follows an apnea or periods of shallow breathing. Sometimes it can be caused by a reflex such as when the baby is sucking or having a bowel movement.
Compared to the average newborn's heart rate of 140 beats per minute, an infant is considered to have bradycardia when:
The heart rate is below 100 beats per minute in a premature infant
The heart rate is below 80 beats per minute in an infant born to term
The heart rate is 60 beats per minute in an infant three months or older
The drop in heart rate is considered normal if the heart rate returns to normal by itself within five to 10 seconds.
The treatments for bradycardia vary depending on cause. It's important to discuss treatment options with your child's physician or call the Infant Apnea Center at 402-481-8933 for more information.
Bryan Infant Apnea Center provides interpretive summaries of monitor download tracings and recommends possible diagnostic and treatment options. When used properly, the monitor can be used as an effective diagnostic tool, as well as an alert system. Unexpected conditions including heart rhythm irregularities have been diagnosed using home cardio-respiratory monitoring.
24-hour availability for equipment support and troubleshooting alarms is provided by the local durable medical equipment vendor.
The Infant Apnea Center staff is available Monday through Friday 6:30 a.m. to 4:30 p.m. You can call us at 402-481-8933 during regular hours. After hours, call the hospital operator at 402-489-0200 and ask for the Infant Apnea Center on-call staff.
Rapid Interpretation of Downloads
Using Respironics software, the Infant Apnea Center can download data from anywhere in the United States. We will score and interpret the downloaded tracings and fax or email a report to the primary care provider within 24 hours.
The Infant Apnea Center coordinates downloads of monitor-recorded data every four-to-six weeks, or more often as needed. As the Bryan Infant Apnea Center Medical Director, Dr. Niazi provides interpretations and recommendations to the primary physicians in a timely manner.
When properly used, event-recording monitors are more cost-effective than less sophisticated equipment.
We offer individual consultation with families regarding the use of equipment, identification of apnea and apnea interventions. The Infant Apnea Center nurses follow-up by phone with new monitor families daily for the first week. All monitor families are contacted weekly.