Apnea of infancy

By
Dr/ Khadiga Zain
 APNEA OF INFANCY

Apnea of infancy (AOI) generally refers to pathologic

apnea in infants of more than 37 weeks' gestation.
The clinical presentation of AOI is an (An apparent
life-threatening event ALTE) (previously referred to by
the inaccurate and misleading expression "near-miss
SIDS") that is described as:
• Frightening to the observer, who fears the child died
or would have died without vigorous intervention
 APNEA OF INFANCY

Some combination of:

▪ Apnea—Cessation of breathing for 20 seconds or more
▪ Color change—Cyanosis or pallor, but sometimes plethora
▪ Marked change in muscle tone—Usually marked hypotonia
▪ Choking or gagging
AOI can be a symptom of many disorders, including:

• Sepsis,
• Seizures,
• Upper airway abnormalities,
• Gastroesophageal reflux,
• Hypoglycemia or other metabolic problems,
• Impaired regulation of breathing during sleep or
feeding,
• A result of intentional poisoning by a caregiver.
(In about half the cases no cause is identified).
Diagnostic evaluation

• It is recommended that any infant

experiencing an ALTE be admitted to an

appropriate acute care center for evaluation of

the event, which involves a detailed history

and physical examination.

Diagnostic evaluation

The most widely used test for evaluating apneic

events is continuous recording of

cardiorespiratory patterns e.g

(cardiopneumogram or pneumocardiogram).

• Monitor heart rate, respirations , nasal airflow,

and oxygen saturation.

Diagnostic evaluation
• A more sophisticated test, polysomnography ("sleep

study"), also records brain waves, eye and body

movements, esophageal manometry, and end-tidal

carbon dioxide measurements.

• However, none of these tests can predict risk. Some

children with normal results may still have subsequent

apneic episodes.
Therapeutic Management

• Continuous home monitoring of cardiorespiratory rhythms.

• The criteria for discontinuing the monitoring is based on the infant's

clinical condition.

• A general guideline for discontinuation is when infants with ALTEs

have gone 1 or 2 months without a significant number of episodes

requiring intervention.
 Therapeutic Management

• Newer home apnea monitors allow download of

information which assists the practitioner in the decision

about when home monitoring may be discontinued.

• It is imperative to keep in mind however that the home

apnea monitor will not predict or prevent SIDS deaths.