When babies have respiratory pauses, the usual initial intervention is tactile stimulation of some kind. Which leads to a few questions: does it work? how does it work (if it does)? what mode of stimulation is most effective?

If you just wait and don’t stimulate an apneic baby, most of them will start breathing again, eventually. I say that from analysis of hundreds of recordings of respiratory patterns of preterm babies, of whom about half the apneic spells were detected by caregivers. In the half that were not detected, the babies all eventually restarted breathing. Including one apnea of over 2 minutes that I recorded once…

I think it is likely that shaking, rocking, flicking, or otherwise stimulating an apneic baby does get them to breathe sooner than they would if left to their own devices, but by how much?

As this is such a frequent intervention in the NICU it would be great to have some actual data, and maybe a systematic review… Voila! Cramer SJE, et al. Effect of Tactile Stimulation on Termination and Prevention of Apnea of Prematurity: A Systematic Review. Front Pediatr. 2018;6:45. This review includes, finally, a very small number of babies, mostly in cross-over studies examining mechanical stimulation devices, and suggests that yes, shaking babies who are not breathing probably gets them to start breathing again more quickly; but how?

I am not sure of the usual explanation, which is that shaking babies wakes them up, so they start breathing again. Maybe, maybe not. Spontaneous termination of apneas can certainly occur without arousal, and there is some evidence that tactile stimulation can increase respiratory drive, even in the absence of arousal. What is the most efficient and least harmful way of stimulating an apneic baby? I don’t know, I usually try to gently shake a leg, but flicking the sole of the foot, or rubbing the back might work faster, it would be nice to know. Randomized controlled trials, anyone?