Case 1: Recurrent Apnea in a Preterm Neonate

Abstract

A preterm male infant is born at 29-2/7 weeks of gestation to a 25-year-old primigravida Asian Indian mother who conceived after infertility treatment. She is admitted for preterm labor pains and receives 1 dose of betamethasone 12 mg intramuscularly at admission. ### Birth Details The neonate is delivered vaginally and has a birthweight of 1,050 g. He does not require resuscitation at birth and his Apgar scores are 7 and 8 at 1 and 5 minutes, respectively. ### Nursery Admission Course The neonate is transferred to the nursery in view of prematurity, very low birthweight, and respiratory distress. At admission, he has a respiratory distress score of 2/10 (Silverman score) for which continuous positive airway pressure (CPAP) is initiated at 5 cm H2O and fraction of inspired oxygen of 50%. The neonate is weaned off CPAP 72 hours after birth. He has an episode of apnea (requiring bag and mask ventilation) 6 hours after weaning off CPAP. CPAP is reinitiated and complete evaluation for an underlying cause of apnea is conducted (sepsis evaluation, serum calcium, serum electrolytes, blood dextrose, head ultrasonography, echocardiography, and chest radiography), all of which are normal. Oral caffeine is initiated after a loading dose. CPAP is continued and a weaning trial is started on day 10 after birth, which the infant tolerates, and he is weaned to room air on day 12. He has …