Clinical audit on management of apnea of prematurity in neonatal intensive care unit

Abstract

Introduction Apnea of prematurity (AOP) is one of the most common diagnoses in the neonatal intensive care unit (NICU). An apneic spell is usually defined as a cessation of breathing for 20 s or longer or a shorter pause accompanied by bradycardia, cyanosis, or pallor. The incidence of AOP increased with decreasing gestational age. Essentially, all infants born at less than or equal to 28 weeks of gestation were diagnosed with apnea. Apnea may be obstructive, central, or mixed. Idiopathic AOP is mostly of mixed etiology (50–75). The physiopathological mechanism underlying AOP is not fully clear, but is certainly linked to the immaturity of the central nervous system of the preterm neonate. Apnea is a diagnosis of exclusion. It usually resolves by 36–37 weeks' corrected age without long-term sequelae. Patients and methods The study includes all preterms at NICU in Assiut University Children Hospital with idiopathic apnea of prematurity in a period of 1 year (March 2018–March 2019). The study included 50 preterm neonates admitted to the NICU with idiopathic AOP. Their ages ranged from 27 to 34 weeks, 27 male and 23 female. The study is a clinical audit to detect the adherence of physicians to the Protocol for Management of AOP at NICU in Assiut University Children Hospital. Results A total of 54% were males whereas 46% were females. Gestational age of the studied cases range from 27 to 34 weeks with a mean age of 30.4 ± 1.99 weeks. Caffeine citrate treatment was given in 100% of the studied cases; 68% of them showed good response to caffeine citrate therapy. A total of 86% of the studied cases improved and discharged without further attacks of apnea; 14% of the studied cases died during the study due to complications and sequela of the disease. Conclusion Stark's 2016 Guidelines have been followed in the management of idiopathic pnea of prematurity in the studied cases but there were some defects that can affect the outcome of management of idiopathic apnea of prematurity. The study recommends avoiding these defects.