[P377]Pictures Of Premature Babies

Layne Melzer awoke around 8 a.m. Jan. 6 and looked at his 6-week-old son, Shane, beside him. Most mornings, it was the baby who roused him at dawn with lusty yells for food, so Melzer was surprised to find Shane still asleep. Then he took a closer look. Shane's skin was dusky, and he did not seem to be breathing. Melzer jiggled him tentatively, but the baby did not rouse. His color was darker now. Bluish.

Yelling to his wife to call 911, Melzer grabbed Shane and shook him -- hard this time. The baby's eyes opened at one point, but his gaze was blank.

Frantically trying to recall resuscitation techniques, Melzer put his mouth over Shane's and puffed twice. Then he turned the baby over and slapped him on the back. He slapped him again, and then a third time. Suddenly Shane gulped for air and began to cry. A moment later, the rescue squad arrived.

The crisis, though, was far from over. By noon, Shane was admitted to Childrens Hospital of Orange County with a tentative diagnosis of severe apnea.

The term apnea comes from the Latin words a and pneuma, which means without air. Medically, it refers to pauses in breathing.

The main consequence of apnea is damage to the brain and heart because of repeated periods of inadequate oxygen. A baby with untreated apnea can, in later years, exhibit learning and behavioral problems, even cerebral palsy, associated with brain damage.

Shane Melzer's problem was central apnea, exacerbated by a viral infection.

Shane's breathing pauses were found to be frequent, long and responsible for repeated episodes of bradycardia -- the medical term for an abnormally slow heart rate. He met all the criteria for a diagnosis of severe apnea. Two days after being admitted to CHOC, he was transferred to the intensive care unit.

He just got worse. At 3:30 the morning following his transfer, the Melzers were awakened by a call from a doctor in the unit. Shane's apnea was so bad that he now required the assistance of a respirator to survive, the doctor told them. But Shane was fortunate to be in a hospital with expertise in the treatment of apnea.

Shane's apnea has caused no more trouble. His breathing pauses have never been severe enough to trigger the monitor, his parents report, and in every other respect, he is thriving.

Are SIDS And Sleep Apnea Related?

A study suggests that sudden infant death syndrome (SIDS) might be more common in families that suffer from the adult sleeping disorder sleep apnea

Though the cause of SIDS remains mysterious, new evidence supports the idea that both disorders are caused by a narrowed upper airway resulting from the way the skull is formed, a characteristic that is inherited.

The study compared the number of SIDS cases in 29 families with sleep apnea and 35 families without sleep apnea. Researchers had families fill out questionnaires about the incidence of infant death. Subjects provided data from four generations of each family so that 352 sleep apnea family members and 408 control family members were covered.

The families prone to sleep apnea -- in which breathing stops for short periods during sleep and can lead to snoring or disturbed sleep -- reported eight unexplained infant deaths. The control families reported no unexplained, unexpected infant deaths, although one infant had died of mother-child blood-type incompatibility. Two of the sleep apnea families reported more than one SIDS death. In one case, a pair of twins had died without explanation. When researchers examined the facial structure of four of the six families that reported SIDS death, they found the shapes were significantly different from the normal families.

The results suggest that SIDS and adult sleep apnea are associated and that both could result from obstructive apnea due to facial structure narrowing the upper airway.

Sleep apnea runs in families. Other work has suggested that certain families may be at higher risk for SIDS, although like most things about SIDS, this remains debated. It is a thorny issue. The idea has been that sleep apnea may be the final common pathway of SIDS, but not necessarily the cause. The problem with SIDS research is that no one has ever witnessed a SIDS death.

In children who often appear tired or have trouble staying awake in school, check for potential obstructive apnea caused by abnormally large adenoids or tonsils.

Another study that found that babies considered at high risk of SIDS -- those who had stopped breathing and were by chance found and resuscitated -- had a higher chance of having a father with sleep apnea-like symptoms. This could support the idea that sleep apnea is related to SIDS. But how they are related and whether it is causative is another question.