Apnea of prematurity (AOP) is a common concern in premature infants. Routine clinical management of the obstructive subtype involves providing continuous positive airway pressure (CPAP) ventilation to prevent alveolar atelectasis and pharyngeal collapse, apart from prone positioning. In central apnea, methylxanthine therapy is mainstay of treatment as it stimulates the central nervous system and respiratory muscle function [1]. Peripheral tactile stimulation is the most common intervention for AOP as it helps in reducing apnea episodes. It works by generating excitatory, nonspecific neuronal activity in the brainstem to stimulate respiration [2]. Tactile stimulation has the potential to substantially reduce the frequency of apnea [3].

Devices for stimulation like oscillating mattress are not available in most of the neonatal intensive care units. We recently managed a case of recurrent apnea in a preterm infant by providing peripheral stimulation in a unique way. The baby was a 27-week-old preterm neonate who developed recurrent apnea and required mechanical ventilation for the same, apart from intravenous caffiene, red blood cell transfusion and intravenous antibiotics for infection. Ultrasonography of the cranium was normal. Baby was finally extubated but she was still having apneic episodes, improved by tactile stimulation. We connected the end delivery limb of the ventilator tubing to a glove (Web Video I), and the ventilator was started with average settings. Baby’s foot had contact with the air filled glove that provided repeated gentle stimulation. After providing tactile stimulation with this technique, the frequency of apnea reduced drastically. In next 48 hour period, baby had only 2 episodes of apnea, which also subsided on their own. We believe that it is an easy bedside method to provide gentle tactile stimulation, and can be tried in cases of intractable apnea. The rate of stimulation can be set as per the respiratory rate of ventilator. The impact can be set by setting Peak Inspiratory Pressure (PIP). We suggest that this method of providing tactile stimulation should be tested in form of research studies.

1. Zhao J, Gonzalez F, Mu D. Apnea of prematurity: from cause to treatment. Eur J Pediatr. 2011;170:1097-105.

2. Gaugler C, Marlier L, Messer J. Sensory stimulations for the treatment of idiopathic apneas of prematurity. Arch Pediatr. 2007;14:485-9.

3. Kattwinkel J, Nearman HS, Fanaroff AA, Katona PG, Klaus MH. Apnea of prematurity. Comparative therapeutic effects of cutaneous stimulation and nasal continuous positive airway pressure. J Pediatr. 1975;86:588-92.