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