Periodic breathing, which may occur in normal neonates, should be differentiated from apnea. However, periodic breathing may precede apnea, and both may occur in the same patient. Apnea is a cessation of respiration for 10 to 20 s with or without bradycardia and cyanosis. It signifies critical illness and warrants prompt investigation and admission for monitoring and therapy.
Apnea may be precipitated by any of the disease conditions listed in Tab.!e ll2.:4 and usually indicates respiratory muscle fatigue and impending respiratory arrest. Resuscitation, including airway support and ventilation, should be followed by a thorough search for the inciting condition. If no obvious cause is found, the neonate should be assumed to be septic. Cultures should be obtained and broad-spectrum antibiotics started. 3 39
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