A term neonate with recurrent central apnea was evaluated at our neonatal intensive care unit (NICU). This male neonate, weighing 3800 g, was vigorous at birth following a caesarian delivery at 38 weeks of gestation. He required continuous positive airway pressure (CPAP) support initially for transient tachypnea but subsequently could not be weaned off as he had recurrent apneas. There was no significant antenatal history. The neonate had recurrent respiratory pauses of 10-40 seconds duration, associated with desaturation/bradycardia, majority requiring stimulation. There was no identifiable cause for apnea in this neonate despite extensive work-up (septic work-up/biochemistry/echocardiography/CSF analysis/neuroimaging/EEG/gastroesophageal reflux evaluation/upper airway study/ metabolic screening). The neonate was then labelled as having primary/idiopathic apnea, and was started on trial of caffeine therapy after discussion with parents. Caffeine citrate (20mg/kg) was injected intravenously, followed by 10 mg/kg every 24 hourly. There was noticeable improvement in symptoms, and the neonate was weaned off from CPAP support after 3 days; he was discharged at 3 weeks of postnatal life on oral caffeine. Post-discharge home monitoring with pulse-oximeter recorded no apneas. Follow-up of the infant showed lag in weight velocity which catched-up after stopping caffeine at four month of age. Developmental milestones were appropriate for age.

1. Jing Z, Fernando G, Dezhi M. Apnea of prematurity: From cause to treatment. Eur J Pediatr. 2011;170:1097-105.

2. Jeffrey JT, Howard PG. Temporal lobe hemorrhage in the full-term neonate presenting as apneic seizures. J Perinatol. 2004;24:726-9.

3. Sirsi D1, Nadiminti L, Packard MA, Engel M, Solomon GE. Apneic seizures: A sign of temporal lobe hemorrhage in full-term neonates. Pediatr Neurol. 2007;37:366-70.