Apnea

ap·ne·a

noun

a temporary suspension of breathing, occurring in some newborns (infant apnea) and in some adults during sleep (sleep apnea)

(Source: "Apnea." Dictionary.com.)

I had heard of sleep apnea before having a premature baby, but I had always associated it with adults, particularly those who are obese. In the weeks following Buzzy's birth, however, the word became a part of our vocabulary. It was one of the first questions we would ask upon arriving at the hospital each day: How many apneas did she have during the night? It was surreal how normal this question became. Also surreal was the common response to an apnea. The alarm would sound, and a nurse would come into the room to check the monitor. When it showed that the baby's breathing rate had dropped below what it was supposed to be, the nurse would jokingly tell the baby to stop holding his or her breath. As we became seasoned NICU parents, we often found ourselves taking cues from the nurses for whom apneas and alarms were simply part of the job. That's what 72 days in the NICU does for a person.

It seems to be a common experience for new parents to check on their sleeping babies to make sure they are still breathing. With all the attention SIDS gets, this should come as no surprise. However, as the mother of a preemie, I have to chuckle a bit at the sense of panic induced in the parent of a full-term baby with no health problems. Though their fears are not completely unfounded, these parents have much less to worry about. For the parent of a preemie, the question as to whether the baby is still breathing is much more complex. The following information from the March of Dimes on the subject of apnea in premature babies explains why:

Premature babies sometimes do not breathe regularly. A baby may take a long breath, then a short one, then pause for 5 to 10 seconds before starting to breathe normally. This is called periodic breathing. It usually is not harmful, and the baby will outgrow it.

Premature and sick babies also may stop breathing for 15 to 20 seconds or more. This interruption in breathing is called apnea. It may be accompanied by a slow heart rate called bradycardia. Babies in the NICU are constantly monitored for apnea and bradycardia (often called “A's and B's”).

Sensors on the baby's chest send information about his breathing and heart rate to a machine located near the incubator. If a baby stops breathing, an alarm will begin beeping. A nurse will stimulate the baby to start breathing by patting him or touching the soles of his feet. The neonatologist might consider giving the baby medicine or using equipment, such as C-PAP (continuous positive airway pressure; delivery of air to a baby's lungs through either small tubes in the baby's nose or through a tube inserted into the windpipe).

(Source: "Common conditions treated in the NICU." March of Dimes website.)

With Buzzy, we dealt with all of the above: short breaths, long breaths, pauses between breaths, bradycardia (which will be the subject of tomorrow's post), monitors (both in the hospital and at home), stimulation, medication, CPAP (which was secured in place by a device that resembled aviator goggles), and a tube in her nose to deliver oxygen. There were some frightening moments, especially after we went home and there was no nurse to constantly monitor these things. There were also comically frustrating moments when one of us would accidentally yank the cord out of the home monitor, causing it to go off in a rather shrill manner. It was a moment like this that earned me the right to pick up my older daughter from preschool in the lane reserved for the day care vans rather than get out of the car with baby and monitor and wait outside the classroom door with the other parents.

Today, the apnea monitor is a thing of the past. Buzzy has done as she should and outgrown her inconsistent breathing, and it has been over a year since a courier came to pick up the thing that went everywhere with us for six months.  Sometimes, though, I find myself watching her as she sleeps and wondering if she's still breathing. I breathe a sigh of relief that she is.