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Pediatric Pulmonology, Allergy, and Sleep Medicine

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New York State-Approved Infant Apnea Center
For appointments or to call us, call 914-493-7585

The Pediatric Pulmonology, Allergy and Sleep Medicine Division hosts the only New York State Approved Infant Apnea Center in the lower Hudson Valley.  Our center specializes in the diagnosis of apnea in infants.  Apnea refers to a brief cessation of breathing, a common occurrence in young infants; particularly those born prematurely.

Patients that suffer from apparent apneic spells are referred to us from physicians throughout the Hudson Valley.  Our physicians are skilled in performing and interpreting tests required to understand why these episodes are occurring and if necessary, recommending appropriate treatment.

Are there different types of Infant Apnea?

Yes, it is often difficult to determine by observation alone the etiology of apnea of infancy.

Central Apnea refers to episodes that occur when infants simply pause in their breathing.  Short pauses in breathing are seen in even in normal healthy infants, though apnea could be a symptom of serious underlying disorders.  It is important to distinguish between the two.  Parents will sometimes be concerned their newborn is having significant apnea, which turn out to be normal short pauses of no consequence.

Obstructive Apnea refers to pauses in breathing that occur because babies are trying to breathe, but cannot because their upper airways partially collapse.  Again, this can sometimes be normal.  Obstructive apnea can be related to irritation or inflammation in the large airways, or due to actual anatomical narrowing up the airways.  Sometimes infants whose muscles are weak have obstructive apnea because they cannot keep their upper airway from collapsing.

Mixed Apnea refers to episodes which include obstructive apnea combined with central apnea.  These combination episodes are much more common than previously recognized.  Sometimes they start with central apnea and end with obstructive apnea.  Sometimes they occur in the opposite order. These occur both in premature infants and infants born full term.

Periodic Breathing is quite common, and refers to long runs of brief apnea one after the other.  Many completely healthy infants have brief pauses in breathing, with no consequences.  Periodic breathing is expected in premature infants but most often resolves within a few weeks of the infant’s original due date.  Unfortunately, some infants have long runs of recurrent brief apnea which last longer than that or have important consequences.

What are the consequences of Infant Apnea?

Infant apnea can be a normal part of development in babies who are still learning how to breathe, with no consequences.  However, if apneic episodes last a long time (usually 15 seconds or greater), they may result in decreases in the amount of oxygen in the blood, which is often referred to as desaturation.  Less commonly, these episodes may also trigger a decrease in the heart rate of babies (bradycardia).  Our physicians are trained in ascertaining whether apneic episodes are causing consequences that require treatment.

How do we diagnose infant apnea?

There are a variety of tests that help determine the cause of apnea.  One common test is called a pneumocardiogram, often abbreviated as a pneumogram.  This is a safe test that involves taping two small electrodes to the chest of the baby which then record the baby’s breathing on a computer.  These studies are routinely continued for about 12 hours while a baby sleeps.  These computer records are then scored and analyzed by our expert physicians.  We can arrange for these studies to be done either in the hospital or at home.

We often combine a pneumocardiogram with continuous monitoring of oxygen saturation of the blood by taping a small probe to an infant’s finger or toe and connecting that probe to a device called an oximeter.  Oximetry data is also recorded simultaneously so that we can determine if any pauses in breathing seen on the pneumocardiogram causes simultaneous changes in oxygen saturation on the oximeter. 

Four-channel pneumocardiography:
A standard pneumocardiogram is designed to document central apnea, but cannot always detect obstructive apnea or mixed apnea.  Sometimes, we also add a fourth channel which involves taping a small probe just below the baby’s nose to detect the flow of air.  With obstructive apnea, the recording will demonstrate that the baby is making an effort to breathe, but cannot move any air because flow is obstructed.

Rarely, we cannot completely determine the etiology of infant apnea with the simple studies described above.  In those situations, we may recommend a complete sleep study, known as polysomnography. Babies then spend the night in our accredited sleep lab and a technician spends the whole night with the baby.  We have a bed for a parent to sleep right next to their infant’s crib. During this study, we add many other channels of data to better delineate if the baby is having significant breathing abnormalities while asleep.  This is called sleep-disordered breathing.

pH probe monitoring:
Infants often have gastroesophageal reflux (GER), which refers to movement of a small amount of formula or stomach contents up from the stomach into the esophagus.  Most of the time this is normal and of no consequence.  Sometimes it appears the GER can trigger infant apnea.  When this is suspected and doesn’t respond to simple forms of therapy, we sometimes recommend that a very thin spaghetti-like probe be passed through the nose of infants and taped into place so that the very bottom of the probe is in the esophagus.  This pH probe then monitors the amount of stomach acid that flows up from the stomach while a baby sleeps or after a baby eats.  This data is also recorded, usually for 12 to 24 hours and is analyzed by our experts to determine whether the amount of reflux is abnormally high, or more importantly whether this results in either infant apnea or decreases in oxygen in the blood (desaturation.)

How do we treat Infant Apnea?

There are a variety of treatments, and sometimes no treatment is necessary.  Our physicians are trained to use the least amount of therapy necessary, since most of the time infant apnea is mild and resolves in just a few months.  If, however, treatment is necessary there are medications such as caffeine or theophylline that often solves the problem.  If our professionals believe GER may be playing a role in triggering apnea, therapy directed to either decreasing reflux or at least decreasing the acidity of stomach contents can often dramatically help.  Rarely, more complex technology is required to control apnea, including nasal CPAP or BiPAP.

What is the role of Infant apnea monitors?

After an infant experiences apnea, parents are understandably quite frightened, worrying that these episodes will happen again.  Therefore, sometimes it is helpful for infants to sleep with an infant apnea monitor for a few months until we are all certain that the problem is completely resolved. Infant apnea monitors are most often prescribed for premature infants who are preparing for discharge from neonatal intensive care units (NICUs).

If a baby is discharged from the hospital on an infant apnea monitor, it can be very important that they be followed by an infant apnea specialist.  Our function is to adjust the doses of any medications as babies rapidly gain weight, otherwise apnea may recur.  We are also trained in how to best wean medications safely off as baby’s mature and no longer need treatment.  We are available 24/7 to help parents solve any problems that may occur with apnea monitors.  We are experts in assessing the significance of any alarms that may occur at home and minimizing any false alarms. Many primary care physicians appreciate our help with these issues.

Infant apnea monitors do not stop babies from having apnea, but simply alarm if it occurs.  For some parents, infant apnea monitors can be tremendously helpful.  However, like any technology, monitors can sometimes alarm for no reason (false alarms), and therefore add to anxiety instead of relieve anxiety.  We urge parents of all infants on apnea monitors to consider the help of our physicians.  We are trained in solving false alarms and helping parents until monitors are discontinued.   In general, most monitors can be safely discontinued before infants are about six months of age.

Is there a relationship between Infant Apnea and Sudden Infant Death Syndrome?

Sudden Infant Death Syndrome (SIDS or crib death) does occur, but much less frequently since we learmed how important it is that all young infants sleep on their back, not their belly.  However, we still do not understand why some babies die of SIDS, and there may be many causes.  While it is possible that some infants that die of SIDS have had infant apnea beforehand, infant apnea is a lot more common than SIDS and there may be no relationship between the two problems.  Unfortunately, infant apnea monitors have not been shown to decrease the occurrence of SIDS.  SIDS very rarely occurs in siblings of infants that have died of SIDS in the past, but parents who have suffered such a devastating loss are understandably particularly frightened until their new baby is older and past this risk.  Physicians throughout the Hudson Valley often refer new parents who have last an infant to SIDS in the past.  Our job is to refer the history and any laboratory tests obtained on an infant who have died and determine if it makes sense to perform any diagnostic tests on subsequent siblings.  For instance, there are occasionally rare genetic diseases that run in families that should be considered.  These evaluations can be started even before a baby is born.  This may or may not include the prescription of an infant apnea monitor for a few months, though once again, there is no evidence that apnea monitors can protect a baby from such a horrible event.

How can parents see an Infant Apnea expert?

Our pediatric pulmonologists are all trained experts in the diagnosis and management of infant apnea.  Our main offices are at 19 Bradhurst Avenue, Hawthorne, New York, just across the street from the Maria Fareri Children’s Hospital at Westchester Medical Center.  For convenience we also see patients at seven outreach offices throughout the Hudson Valley.  For a list of all offices and their addresses, see our faculty practice website: