0071643192.pdf

PEDIATRICS

PULMONARY

Apnea of Prematurity and Acute Life-Threatening Event

Apnea is defined as 20 seconds of no respirations, or by a shorter period

accompanied by cyanosis. Apnea of prematurity generally resolves shortly

after birth, but premature infants are at risk for recurrent episodes of apnea

and bradycardia. These episodes are called apparent life-threatening events

(ALTE). Clinically, the history is crucial for determining the severity of an

event and the degree of evaluation required.

SYMPTOMS/EXAM

■ In the ED, all symptoms may be gone and the infant may appear normal.

■ Cyanosis, pallor, loss of consciousness, or loss of muscle tone all suggest a

potentially lethal event.

DIAGNOSIS

■ An accurate history is essential.

■ Supporting data including serum glucose, electrolytes, CBC, and an ECG

may be helpful.

■ CT head, CXR, UA, and cultures of blood and urine may also be useful.

TREATMENT

■ Supportive, with specific therapy directed toward the cause of the event.

■ In general, infants with an ALTE should be admitted to a monitored bed.

A 2-year-old boy becomes upset after his parents take away a favorite toy.

He cries vigorously, then becomes limp, cyanotic, and his parents describe

seizure-like activity. Upon arrival in the ED, he is alert with normal vital

signs and a normal physical exam. What is the appropriate ED workup?

Reassurance and education.

Breath Holding

Breath holding is a behavioral response to being emotionally upset. It typically

occurs in children between the ages of 6 months and 5 years with the peak

incidence at 2 years of age.

SYMPTOMS

■ Loss of consciousness

■ May have associated pallor or cyanosis

■ May have associated clonic jerks

■ No postictal period

EXAM

Normal vital signs and normal physical exam.

Causes of apnea

and bradycardia in

infants—

HAS CRASH

Hypoglycemia

Aspiration

Sepsis (infections:

Respiratory syncytial

virus [RSV], pertussis)

Cardiac arrhythmias

Reflux

Anemia

Seizures

Hydrocephalus