Prolonged Infantile Apnea: 1985

Abstract

Knowledge regarding the etiology and optimal management of prolonged infantile apnea and its relationship to sudden infant death syndrome (SIDS) is tentative. Consequently, infantile apnea is a controversial subject; professional discussion and media attention are often emotional and even erroneous. Prolonged apnea is defined as cessation of breathing for at least 20 seconds or as a briefer episode of apnea associated with bradycardia, cyanosis, or pallor. Brief episodes of apnea are a normal occurrence in infants, but prolonged apneic episodes may lead to morbidity and rarely mortality. The vast majority of infants with prolonged apnea are not victims of SIDS; most SIDS victims were never observed to have had prolonged apnea prior to the terminal event. The risk of death from SIDS is somewhat greater in the group of infants with prolonged apnea than in the general population. Infants with sleep apnea who have required active intervention, such as positive pressure "resuscitation," may be at significant risk. Apnea of undetermined etiology that occurs in the premature infant between the actual date of birth and the original due date is apparently not predictive of SIDS. There is, however, indication that preterm infants as a group and perhaps siblings of infants who were victims of SIDS are at somewhat increased risk. Infants who have had an episode of prolonged apnea are perceived by parents and physicians as having experienced a life-threatening event and being at risk for another. Prolonged apnea can be a symptom of many disorders including infection, seizures, airway abnormalities, hypoglycemia or other metabolic problems, anemia (in preterm infants), gastroesophageal reflux, impaired regulation of breathing during sleeping and feeding, and abuse.