Layne Melzer awoke around 8 a.m. Jan. 6 and looked at his 6-week-old son, Shane, beside him. Most mornings, it was the baby who roused him at dawn with lusty yells for food, so Melzer was surprised to find Shane still asleep. Then he took a closer look.
Shane's skin was dusky, and he did not seem to be breathing. Melzer jiggled him tentatively, but the baby did not rouse. His color was darker now. Bluish.
Yelling to his wife to call 911, Melzer grabbed Shane and shook him--hard this time. The baby's eyes opened at one point, but his gaze was blank.
Frantically trying to recall resuscitation techniques, Melzer put his mouth over Shane's and puffed twice. Then he turned the baby over and slapped him on the back. He slapped him again, and then a third time. Suddenly Shane gulped for air and began to cry. A moment later, the rescue squad arrived.
The crisis, though, was far from over. By noon, Shane was admitted to Childrens Hospital of Orange County with a tentative diagnosis of severe apnea.
The term \o7 apnea\f7 comes from the Latin words \o7 a\f7 and \o7 pneuma\f7 , which means without air. Medically, it refers to pauses in breathing.
Everyone pauses in breathing. If you take a deep breath, you probably won't breathe again for several seconds because your body has more than enough oxygen. When the oxygen starts to get used up, the brain sends a signal, and you feel the urge to breathe again. That ends the apnea spell.
But apnea becomes a medical problem when the pauses in breathing are unusually frequent, slow the heart's beating rate or last longer than 20 seconds, says Dr. Carrie C. Worcester, director of the neonatal intensive care unit at CHOC.
Apnea is sometimes misunderstood to be a precursor of sudden infant death syndrome, in which apparently healthy babies mysteriously die during sleep.
But children with apnea rarely die, Worcester says. And there is no evidence that a baby with apnea is at greater risk for SIDS.
The main consequence of apnea is damage to the brain and heart because of repeated periods of inadequate oxygen, Worcester says. A baby with untreated apnea can, in later years, exhibit learning and behavioral problems, even cerebral palsy, associated with brain damage.
Apnea usually falls into one of two diagnostic categories: obstructive apnea or central apnea.
In obstructive apnea, the brain sends the appropriate signals for breathing, but some type of blockage in the airway prevents adequate oxygen flow. In older children, enlarged adenoids or tonsils may cause apnea-like symptoms such as decreased blood oxygen levels and slowed heartbeats. Sometimes apnea is the secondary result of a condition called gastro-esophageal reflux, in which weakness in the muscular ring at the junction of the stomach and esophagus results in food and stomach acids backing up into the trachea or windpipe.
When the underlying causes of obstructive apnea are treated, the breathing problem usually goes away, says Julie A. Herda, the apnea nurse specialist at CHOC.
In central apnea, the problem resides in the brain. The signals to breathe are infrequent or irregular, and, as a result, the baby does not take in enough air to meet the needs of its brain, heart and other organs. It is not unusual, Herda says, to find central apnea in premature infants, whose brains are not as developed as full-term babies. The apnea usually resolves into a normal breathing pattern when the babies catch up developmentally, typically by six months of age.
Shane Melzer's problem was central apnea, exacerbated by a viral infection.
He was born at Hoag Hospital in Newport Beach on Nov. 28, seven weeks before he was due. His mother, Corinne Melzer, had been hospitalized for the 10 preceding days in an effort to stop premature labor and give her baby extra time to develop his lungs, a major factor in the survival of premature infants.
The strategy seemed to work. Despite his prematurity, Shane weighed a relatively robust 5 pounds, 1 ounce at birth, and was able to breathe without the help of a respirator. On Dec. 8, after a basic sleep study at Hoag showed no medically significant apnea, Shane was deemed strong enough to go home.
Home for the Melzer family is Lake Forest. The baby quickly adapted to his new environment, eating well and sleeping most of the time, as premature babies tend to do. Corinne Melzer concentrated on helping her other son, Aaron, 2, adjust to his new brother.
Things went relatively smoothly until January, when Corinne, Aaron and Shane all came down with a respiratory virus. Corinne had it the worst, developing strep throat and losing her voice for several days. Shane seemed to have the mildest case, mostly congestion in his nose that was gone after a week.
Layne Melzer saw his wife getting sicker and decided to sleep with Shane in another room so Corinne could at least get a full night's sleep. The following morning, a Saturday, was when he discovered Shane not breathing.