Apnea of prematurity: from cause to treatment

Eur J Pediatr. 2011 Sep;170(9):1097-105. doi: 10.1007/s00431-011-1409-6. Epub 2011 Feb 8.


Apnea of prematurity (AOP) is a common problem affecting premature infants, likely secondary to a "physiologic" immaturity of respiratory control that may be exacerbated by neonatal disease. These include altered ventilatory responses to hypoxia, hypercapnia, and altered sleep states, while the roles of gastroesophageal reflux and anemia remain controversial. Standard clinical management of the obstructive subtype of AOP includes prone positioning and continuous positive or nasal intermittent positive pressure ventilation to prevent pharyngeal collapse and alveolar atelectasis, while methylxanthine therapy is a mainstay of treatment of central apnea by stimulating the central nervous system and respiratory muscle function. Other therapies, including kangaroo care, red blood cell transfusions, and CO(2) inhalation, require further study. The physiology and pathophysiology behind AOP are discussed, including the laryngeal chemoreflex and sensitivity to inhibitory neurotransmitters, as are the mechanisms by which different therapies may work and the potential long-term neurodevelopmental consequences of AOP and its treatment.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Central Nervous System Stimulants / therapeutic use
  • Continuous Positive Airway Pressure
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases* / etiology
  • Infant, Premature, Diseases* / physiopathology
  • Infant, Premature, Diseases* / therapy
  • Intermittent Positive-Pressure Ventilation
  • Prone Position
  • Sleep Apnea Syndromes* / etiology
  • Sleep Apnea Syndromes* / physiopathology
  • Sleep Apnea Syndromes* / therapy
  • Xanthines / therapeutic use


  • Central Nervous System Stimulants
  • Xanthines
  • methylxanthine