Our three-week-old daughter is having brief periods of sleep apnea. She is currently on an apnea monitor during sleep. How "normal" is this and is there anything else we can do?

Noelle

Apnea means no breath. Your daughter has apnea of the newborn, a condition that is not rare but is certainly not "normal." Apnea of the newborn is most commonly associated with prematurity and is most common in very premature infants.

Aside from prematurity, there are a number of conditions associated with apnea of the newborn. Gastroesophageal reflux disease ("bubbling up" of stomach acid and digestive enzymes into the throat), infection, anemia and hypoglycemia (low blood sugar) are treatable causes of newborn apnea. Other causes include intracranial hemorrhage and a history of seizures. Needless to say, every effort should be made to identify treatable causes of newborn apnea.

Apnea is often classified as central, obstructive or mixed. Central apnea occurs when the infant's central nervous system fails to send the appropriate "breathing orders" to the respiratory muscles. In obstructive apnea, the orders are given, but the infant cannot breathe due to anatomical airway obstruction. In toddlers and older children, this is often due to enlarged tonsils and adenoids, but in neonates (newborns) the obstruction is often due to the poor muscle tone of the airway musculature. Thus obstructive apnea, too, is a form of neurologic immaturity. Mixed apnea is a combination of central and obstructive apnea.

Apnea is significant because it can lead to hypoxemia (low blood oxygen content), which in turn can cause brain damage. Apnea can also cause undue strain on your daughter's heart and lungs. Finally, apnea can lead to full respiratory arrest, even death.
Is there anything else you can do? Here's what I would recommend:

• Make sure your daughter's pediatrician has taken steps to learn whether she has any treatable cause for her apnea.
  
• You and your husband must both learn infant CPR (cardiopulmonary resuscitation). If your daughter has a respiratory arrest, time is of the essence. One parent should begin CPR while the other parent calls 911. Ask your pediatrician whether you should also have a tank of oxygen at home and whether you should receive training in bag and mask ventilation.
  
• Make certain that the apnea monitor is maintained in excellent working condition. It must ALWAYS be used whenever your daughter is asleep. Proximity to the parents is NOT a substitute for a working monitor -- in other words, don't assume, "If she runs into problems, I'm sure I'll notice it."
  
• In some cases, medications may be helpful in treating apnea. Discuss this with your pediatrician.
  
• Your pediatrician should be able to advise you regarding the best way to position your daughter during sleep.
  
• During her infancy, if your daughter must undergo general anesthesia (for any reason), she should be monitored closely in the hospital for at least 12 hours postoperatively. That's because infants with a history of neonatal apnea can have a devastating degree of post-anesthesia apnea, even after their problems with neonatal apnea have resolved.
  

You should consider neonatal apnea to be a medical condition, something that is as much a part of her medical record as, for example, a history of penicillin allergy or a broken arm. All of her future doctors should be informed that she had this condition.