Current definitions for neonatal apnoea: are they evidence based?

Area of Science:

• Neonatology
• Pediatric Respirology
• Clinical Definitions

Background:

• Apnoea is defined as cessation of breathing, but current definitions lack clear pathophysiological basis.
• Existing definitions for neonatal apnoea (preterm and term infants) are often arbitrary and inconsistent across studies.
• Current breathing monitor alarms, typically set at >20s pauses, may not align with clinical needs, especially for preterm infants.

Purpose of the Study:

• To review current definitions of neonatal apnoea.
• To evaluate the evidence supporting the use of existing apnoea definitions.
• To explore alternative approaches for defining apnoea based on clinical consequences.

Main Methods:

• Systematic review of literature on neonatal apnoea definitions.
• Analysis of evidence supporting current diagnostic criteria.
• Exploration of physiological parameters associated with respiratory pauses.

Main Results:

• Definitions of neonatal apnoea lack robust scientific support and vary significantly.
• The standard >20s pause duration for alarms is equivalent to many missed breaths in preterm infants.
• Clinical consequences (heart rate, oxygen saturation changes) are proposed as better indicators than pause duration alone, but thresholds remain undefined.

Conclusions:

• Current definitions of neonatal apnoea are inadequate and not evidence-based.
• Further research is crucial to establish definitions based on clinical significance and differentiate pathological events from normal respiratory variability.
• Revised definitions are needed for accurate monitoring and management of respiratory events in neonates.