Prolonged Apnea

Abstract

Prolonged apneic spells in infants may lead to morbidity and occasional mortality. Prolonged apnea is defined as cessation of breathing for 20 seconds or longer, or as a briefer episode associated with bradycardia, cyanosis, or pallor. Present etiological considerations in prolonged apnea include seizure disorders, severe infections, significant anemia (especially in infants who were preterm), gastroesophageal reflux, hypoglycemia and other metabolic disorders, and impaired regulation of breathing. It further seems likely that some victims of the sudden infant death syndrome (SIDS) have succumbed to unrelieved prolonged apnea. Beyond specific treatment of any underlying disorder, 24-hour surveillance is critical to the management of prolonged apnea. Settings for intensive observation and care may include the appropriately staffed and equipped acute care hospital, and the infant's home. In addition, a long-term care facility or foster home may be considered. Skilled care-givers are crucial to continuous observation and management of an infant in any setting. Care-givers should be trained in infant cardiopulmonary resuscitation and provided with continuing medical, technical, and psychosocial support. In the home setting, relief personnel should be available. Electronic or other monitors of the heart or respiratory rate may be useful adjuncts to 24-hour surveillance, but should be used only under medical supervision. There is presently no consensus concerning the relative advantages and disadvantages of cardiac and respiratory monitors-both present problems. Moreover, a successful outcome for every baby with prolonged apnea cannot be guaranteed, despite continuous surveillance (with or without monitors) and appropriate intervention. Pediatricians must keep in mind that there is a significant psychological impact on all the members of the family of an infant with prolonged apneic spells, whether or not monitors are included in the management plan.