Apnea of Prematurity: Why Preterm Babies Pause Breathing and How NICU Care Helps Them Grow

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: September 2026

Apnea of prematurity is a breathing condition affecting babies born before premature birth at 37 weeks, where breathing pauses last 15 to 20 seconds or longer. It happens because the nervous and respiratory systems are still developing. Treatment in the NICU — usually caffeine citrate and breathing support like CPAP — helps the baby until their body can breathe normally on its own. The condition is temporary and improves as the baby grows.

Quick Answer

• Apnea of prematurity is defined by breathing pauses of 15 to 20 seconds or longer in babies born before 37 weeks gestation.

• Shorter pauses also count as apnea if they occur with a slow heart rate (bradycardia) or a low blood-oxygen level (hypoxemia).

• Mixed apnea, involving both the airway and the brainstem, is the most common type in preterm infants.

• The condition is temporary: symptoms improve as the baby grows, and most babies need no home monitoring after discharge.

What Is Apnea of Prematurity?

Apnea of prematurity is a breathing condition that affects babies born before 37 weeks gestation (preterm birth). A baby's body is still growing at that stage, and the parts that support breathing are still developing. The baby is not quite ready to breathe in a normal rhythm yet.

Instead, the baby has periods where they do not breathe at all. Providers call these periods apneic spells.

It can feel frightening to think a baby is not breathing right. But the condition is common among preterm babies, and providers know how to treat it. The baby spends some time in the neonatal intensive care unit (NICU), where providers monitor vital signs and give treatments that support breathing. The baby can usually go home once they breathe normally without treatments.

Definition nugget: Apnea of prematurity is when a preterm baby has breathing pauses lasting 15 to 20 seconds, sometimes with a slow heart rate or low blood-oxygen level, because the nervous and respiratory systems are not yet developed enough to sustain normal breathing.

What Are the Symptoms of Apnea of Prematurity?

Apnea of prematurity has a small set of clear signs and symptoms. The most important is the breathing pause itself.

Pauses in breathing that last 15 to 20 seconds or longer are the defining symptom. Providers also watch for two accompanying warning signs: a slow heart rate (bradycardia) and a low blood-oxygen level (hypoxemia).

Low oxygen can change a baby's skin color. The skin may look blue, white, yellow-gray, or gray — especially the lips and/or tongue. This color change is called cyanosis.

A shorter pause — less than 15 seconds — still counts as apnea if it occurs along with bradycardia and/or hypoxemia. Duration alone does not tell the full story; the combination of signs matters.

Symptom	What It Looks Like	Why It Matters
Breathing pause (long)	No breathing for 15–20 seconds or longer	The defining feature of apnea
Breathing pause (short)	Pause under 15 seconds	Counts as apnea if paired with warning signs
Slow heart rate (bradycardia)	Heartbeat drops below normal range	Signals the pause is affecting circulation
Low blood-oxygen (hypoxemia)	Oxygen saturation falls	Can cause bluish, grayish, or pale skin
Cyanosis	Blue, white, yellow-gray, or gray skin — especially lips/tongue	Visible sign of low oxygen

How Is It Different from Normal Periodic Breathing?

It is important to distinguish apnea from periodic breathing, which is normal in newborns. Periodic breathing involves short pauses of less than 10 seconds with no bradycardia or low oxygen level, followed by rapid breathing. That pattern is considered normal and is not apnea.

Feature	Apnea of Prematurity	Normal Periodic Breathing
Pause length	15–20 seconds or longer (or shorter with warning signs)	Under 10 seconds
Heart rate during pause	Often drops (bradycardia)	Stays normal
Oxygen level	Often drops (hypoxemia)	Stays normal
After the pause	No rapid-breathing pattern required	Followed by rapid breathing
Classification	Needs NICU treatment	Normal newborn pattern

What Causes Apnea of Prematurity?

Apnea of prematurity occurs because a baby's airways and the breathing center in the brain are not fully developed yet. These parts of the body work together to make breathing automatic and continuous. When either part is immature, breathing pauses can happen.

Providers divide apnea in newborns into three main types according to what causes the breathing pauses.

Obstructive Apnea

Obstructive apnea happens when there is a blockage in the baby's airways. These passages carry oxygen-rich air into the lungs and remove carbon dioxide from the body. The airways need to stay open wide enough to let air pass through at all times.

A preterm baby's airways — typically the part passing through the neck — may not be developed enough to stay open continuously. That collapse can cause breathing pauses.

Central Apnea

Central apnea happens when the baby's brainstem — the center in the brain responsible for breathing — does not send out certain signals when expected. Normally, the brainstem sends signals to the respiratory muscles, such as the diaphragm and intercostal muscles. These muscles pull air into the lungs and push it out so the baby can breathe.

If the brainstem is not fully developed, it is not ready to send signals in a predictable or reliable way. That unreliability leads to pauses in breathing.

Mixed Apnea

Mixed apnea happens when the baby's airways and brainstem are both not working as expected. It is the most common type of apnea among preterm infants.

Type	What Causes the Pause	Key Mechanism
Obstructive	Airway blockage	Neck airway not developed enough to stay open
Central	Brainstem signal failure	Immature brainstem sends unreliable signals to breathing muscles
Mixed	Both airway and brainstem	Most common type in preterm infants

How Is Apnea of Prematurity Diagnosed?

Healthcare providers diagnose apnea of prematurity in the neonatal intensive care unit (NICU). This is the area of the hospital for babies who need extra care and medical attention. A baby born preterm may spend some time in the NICU before going home.

While the baby is in the NICU, providers continuously monitor three vital signs: heart rate, breathing, and blood-oxygen level. The monitors alarm if the baby's heart rate drops or if breathing pauses for a certain amount of time. Data from these monitors, combined with nurses' observations, help providers diagnose apnea.

What Else Do Providers Check For?

Apnea in newborns is sometimes a sign of other medical conditions, including metabolic disorders, brain bleeds, and infections. Providers check the baby for signs and symptoms of these conditions and rule out all other causes before diagnosing apnea of prematurity.

An apnea of prematurity diagnosis means the breathing pauses are due to early birth. The nervous system and respiratory system are not fully developed yet. The baby needs a little extra help with breathing until the body is ready to handle things on its own.

Diagnostic Element	What Happens
Monitoring	Continuous tracking of heart rate, breathing, and blood-oxygen level
Alarms	Triggered when heart rate drops or breathing pauses beyond a set time
Observation	Nurses' observations combined with monitor data
Ruling out other causes	Metabolic disorders, brain bleeds, and infections checked first
Diagnosis	Confirmed when pauses are traced to prematurity and immaturity

How Is Apnea of Prematurity Treated?

Apnea of prematurity treatment typically includes one or both of two approaches: medication (usually caffeine citrate) and breathing support.

Caffeine Citrate

Caffeine citrate is a medication providers use to treat apnea of prematurity. Just like a morning coffee gives an adult a jolt, this medicine stimulates the baby's nervous system. This "wake-up call" helps the baby's brainstem and nerve cells send the signals that regulate breathing.

Caffeine helps the baby have fewer apneic spells. It also helps shorten these pauses in breathing.

Breathing Support

A baby's upper airway — the pharynx and larynx — might need help staying open. When that is the case, providers often use continuous positive airway pressure (CPAP). With CPAP, the baby is still breathing on their own. Tiny prongs in the nose send air through the airway. This lowers the risk of breathing pauses caused by airway blockages.

If the baby continues to have severe apneic spells, they may need mechanical ventilation. This means a machine (a ventilator) does the work of breathing for the baby until their body can take over.

Treatment	How It Works	When It Is Used
Caffeine citrate	Stimulates the nervous system; brainstem and nerve cells send more reliable breathing signals	Standard first-line medication; reduces spell frequency and length
CPAP	Tiny nasal prongs deliver continuous airflow that keeps the upper airway open while the baby breathes on their own	When the airway needs help staying open
Mechanical ventilation	A ventilator machine does the work of breathing for the baby	For severe, continuing apneic spells

What Is the Outlook for a Baby with Apnea of Prematurity?

Apnea of prematurity is a temporary condition. Symptoms improve as the baby grows. The baby may spend several weeks — or even a couple of months — in the NICU. They will receive care not just for their breathing but also for any other issues related to preterm birth.

Providers explain how long the baby needs to stay and what needs to happen before the baby can safely head home.

In general, providers first identify when it is safe to stop giving treatments. After stopping treatment, they monitor the baby to see how the body responds. The baby must go a certain number of days without apnea symptoms before providers send them home. The length of this observation period depends on how early the baby was born and their overall health.

Most babies do not need continued monitoring with devices at home. If a baby does need monitoring, providers explain exactly what is involved. Parents should ask if anything is unclear or concerning about caring for the baby at home. Providers make sure families get the information they need to feel comfortable with the transition.

Outlook nugget: Apnea of prematurity is temporary and improves as the baby grows. Discharge requires an observation period of apnea-free days after treatments stop, and most babies go home with no need for continued home monitoring.

Milestone	What Happens
NICU stay	Several weeks to a couple of months, with care for breathing and other preterm issues
Stopping treatment	Providers decide when it is safe to stop caffeine and/or breathing support
Observation period	Baby must go a set number of days without apnea symptoms; length depends on gestational age and health
Discharge	Most babies need no home monitoring; those who do get clear instructions

How Can Parents Cope While Baby Is in the NICU?

Knowing that apnea of prematurity is common among preemies does not make life easier when all you want to do is hold and cuddle your newborn. It is hard being apart from a baby while they are in the NICU. But the condition is temporary.

NICU providers can help parents find ways to spend time with their baby during this period. They also help families understand how the baby's breathing is developing and when the baby might be ready to come home.

Conclusion

Apnea of prematurity is one of the most common challenges a preterm baby faces, and also one of the most manageable. Breathing pauses happen because the airways and the brain's breathing center are still maturing — not because anything was done wrong. Providers diagnose it with continuous monitoring, treat it with caffeine citrate and breathing support, and watch the baby grow until the body takes over on its own.

The condition is temporary. Symptoms improve as the baby grows, and most babies go home without needing any home monitoring at all.

Next steps for parents: ask the NICU team how the monitors work, what caffeine citrate does for your baby, and what the discharge criteria look like. Ask when you can expect the observation period to begin, and what you can do to spend more time with your baby while they are in the NICU.

FAQ

What is apnea of prematurity?

Apnea of prematurity is a breathing condition in babies born before 37 weeks, marked by breathing pauses lasting 15 to 20 seconds or longer, sometimes with a slow heart rate or low blood oxygen, because the nervous and respiratory systems are still developing.

How long can a premature baby stop breathing and still be normal?

Brief pauses can be normal (periodic breathing under 10 seconds with no heart rate or oxygen changes), but pauses of 15 to 20 seconds or longer are considered apnea, as are shorter pauses paired with a slow heart rate or low oxygen.

What are the signs of apnea of prematurity?

The main signs are breathing pauses of 15–20 seconds or longer, a slow heart rate (bradycardia), low blood-oxygen (hypoxemia), and cyanosis — blue, white, yellow-gray, or gray skin, especially on the lips or tongue.

What are the three types of apnea in newborns?

Obstructive apnea (airway blockage), central apnea (immature brainstem signals), and mixed apnea (both). Mixed apnea is the most common type in preterm infants.

How is apnea of prematurity treated?

Treatment usually includes caffeine citrate, which stimulates the nervous system to send more reliable breathing signals, and breathing support such as CPAP to keep the airway open. Severe spells may require mechanical ventilation.

Does caffeine given to babies have any relation to adult caffeine?

Caffeine citrate is the medication used — like a coffee jolt for adults, it acts as a "wake-up call" for the baby's brainstem and nerve cells, reducing the number and length of apneic spells.

Is apnea of prematurity permanent?

No. It is a temporary condition. Symptoms improve as the baby grows, and most babies need no continued monitoring at home once discharged.

When can my baby come home from the NICU?

Once treatments are safely stopped and the baby goes a set number of days without apnea symptoms — the length of this observation period depends on how early the baby was born and their overall health.

Related Reading

• Premature Birth: Complete Guide to Signs, Causes, and Care

References

• Dobson NR, Patel RM. "The Role of Caffeine in Noninvasive Respiratory Support." Clin Perinatol. 2016 Dec;43(4):773-782.

• Eichenwald EC; Committee on Fetus and Newborn, American Academy of Pediatrics. "Apnea of Prematurity." Pediatrics. 2016 Jan;137(1).

• Erickson G, Dobson NR, Hunt CE. "Immature control of breathing and apnea of prematurity: the known and unknown." J Perinatol. 2021 Sep;41(9):2111-2123.

• Gozal D, Kheirandish-Gozal L. Disorders of Respiratory Control and Sleep-Disordered Breathing. In: Kline MW, eds. Rudolph's Pediatrics. 23rd ed. McGraw-Hill Education; 2018.

• Merck Manual (Professional Version), "Apnea of Prematurity."

Medical disclaimer: This article is for general informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider for diagnosis and treatment decisions regarding your baby's health.