Infant Apnea Care

The Infant Apnea Clinic at Children’s Healthcare of Atlanta offers a specialized approach in treating infants with breathing disorders like apnea.

What is apnea?

• Apnea is a medical term which means breathing has stopped for 20 seconds or more. This can happen in full-term babies but is more common in premature babies. Generally, the more premature a baby is, the more frequent apnea spells can be.
• Sometimes apnea can be associated with a low heart rate, also known as bradycardia. Premature infants are more likely to have periods of bradycardia due to immaturity of their lungs and inability to maintain oxygen levels in their blood.
• A home apnea monitor is a device that is placed on an infant to continuously monitor their breathing and heart rate.

The Infant Apnea Clinic offers a valuable resource for parents and families who use a monitor for their infants or children. Common conditions that may require an apnea monitor include:

• Apnea of prematurity
• Premature infants with bronchopulmonary disease (BPD), a chronic lung condition
• Brief resolved unexplained event (BRUE)
• Gastroesophageal reflux or feeding issues
• Congenital anomalies of the airway
• Infants whose siblings have died from sudden infant death syndrome (SIDS)

Our expertise is well recognized. The Infant Apnea Clinic at Children’s treats approximately 800 infants a year for apnea since our inception over 20 years ago. Practicing physicians across the state of Georgia and also neighboring states, such as Alabama, Florida, and Virginia refer their patients to us.

What is bradycardia?

Bradycardia is periods of low heart rate. Premature infants, particularly those born before 32 weeks in utero, are more likely to have periods of bradycardia due to the immaturity of their lungs and the inability to maintain the oxygen levels in their blood. However, as babies mature, their natural heart rates tend to become slower anyway.

Compared to the average newborn's heart rate of 140 beats per minute (bpm), an infant is considered to have bradycardia when:

• The heart rate is below 100 bpm in a premature infant.
• The heart rate is below 80 bpm in an infant born to term.
• The heart rate is below 60 bpm in an infant 3 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.

What is SIDS?

SIDS is the unexplained, sudden death of a child under 1 year old and the top cause of death among infants age 1 month to 1 year old. Research has shown that the majority of infant deaths are sleep related, with nearly 75% of deaths in babies younger than 4 months old occurring when a child is bed-sharing with a parent, sibling or family member.

And while SIDS cannot be treated, we see children whose siblings have died of SIDS, as they may be at a higher risk.

What is a brief resolved unexplained event (BRUE)?

A BRUE is an episode that typically lasts less than one minute and is observed in infants younger than 1 year old in which the child is experiencing one or more of the following:

• Absent, decreased or irregular breathing
• Discoloration of the face, gums or trunk (abdomen area)
• Change in muscle tone
• Altered level of responsiveness

Apnea treatment is designed to protect your baby until he outgrows the problem.

Treatment options may include the following:

• Stimulation can be used to help a baby who is not breathing. It may include rubbing your baby’s back, arms or legs; turning your baby’s head to a different side; or turning your baby over. This kind of stimulation is continued until your baby is clearly trying to breathe again. If your baby remains pale or bluish in color, oxygen may be given.
• Medicines can stimulate the part of the brain that controls breathing and can reduce the number of apnea spells. These medicines can be given directly by IV or mouth. Your baby will keep taking medicine until he has outgrown apnea.
• Monitors that measure the heart rate and respiratory rate are used to detect when a baby needs help. If your baby stops breathing for too long, or his heart rate drops too low, the monitor sounds an alarm to alert the staff. A nurse immediately checks the baby to see if he needs help.

Our team also offers help with at-home monitoring of your infant’s apnea. At Children’s, we:

• Provide 24-hour availability in downloading and reading tracings.
• Quickly receive tracings from all around the world through email and will score and interpret the download tracings and fax or email the report to your baby’s pediatrician.
• Can perform downloads directly from the patient’s home. This requires the local home care company to provide the family with a modem compatible with Respironics monitoring software.
• Provide cost-effective care. When properly used, event-recording monitors are more cost-effective than less sophisticated equipment.
• Offer individual consultation with families regarding the use of equipment, identification of apnea and apnea interventions.

The Infant Apnea Clinic provides a comprehensive program to evaluate, treat and monitor infants with apnea. Infants may be evaluated as an inpatient or outpatient depending on the nature of breathing disorders.

After your infant's complete evaluation, we are able to coordinate your infant's care with other specialists, such as pediatric gastroenterologists, neonatologists or otolaryngologists (ENTs).

Home monitoring offers parents a way to detect any significant changes in the heart rate or breathing pattern. Monitor downloads also provide valuable information, which can be used to offer treatment options for your infant.

Our apnea monitoring program includes:

• Complete evaluation by a pulmonologist and/or nurse practitioner.
• Coordination of home monitoring set up with the homecare companies.
• Education for infant CPR offered at the time of monitor set up.
• Monitor downloading, review and interpretation.
• Parent education and support during the monitoring period by registered nurses and respiratory therapists.
• Outpatient follow up in the Infant Apnea Clinic or Pulmonary Clinic.
• Referral as needed for overnight sleep study.
• Nutritional counseling or referral as needed.
• Education on SIDS prevention.
• Infant car seat re-challenge.

Our integrated team of experienced nurse practitioners, pediatric-trained pulmonologists, pediatric nurses and respiratory therapists are dedicated to providing the best care for neonates, infants and children.

Pediatric pulmonologists

• Ajay Kasi, MD
• Roberta Leu, MD
• Samar Shah, MD
• Dawn M. Simon, MD

Advanced practitioner

• Fran Martinez, NP

Center for Advanced Pediatrics
2174 North Druid Hills Road NE
Atlanta, GA 30329