Apneic Attacks Research Articles

A Case Report of a Suspected Neonatal Alloimmune Thrombocytopenia in a Tertiary Health Institution

Fetal and neonatal alloimmune thrombocytopenia FNAIT is the leading cause of severe thrombocytopenia in the fetus and neonate leading to serious bleeding, intracranial haemorrhage and death and also intracranial haemorrhage in full-term infants. We reported a case of a 33-year-old woman who was delivered of a male neonate via Emergency lower segment Cesarean section CS on account of premature rupture of the membrane with oligo hydramnios at an estimated gestational age EGA of 29 weeks 3 days. Her blood group is O Rhesus D positive, and Genotype HbAA. No known premorbid illness. Her last confinement was of a male child delivered via CS and died within 12 hours of birth. This reported case of suspected FNAIT was a baby received alive after CS with birthweight of 1,060g and APGAR score of 7185 transiently, and was noticed to be bleeding from the mouth and anus shortly after birth. Thereafter, he had thrombocytopenia, persistent anaemia, several apneic attacks, seizures, desaturation and died after 42 hours of life despite all prompt clinical interventions. Autopsy summary includes anaemia, central cyanosis, petechial hemorrhage, diffuse alveolar damage, cerebral edema, acute tubular necrosis, small for gestational age and placental vasculopathy. Conclusion: Fetal and neonatal alloimmune thrombocytopenia is a rare disorder and yet poses a challenging diagnosis and treatment plan in resource-limited centres especially in developing countries. Although the clinical findings of the reported suspected case were not classical as previously reported by other studies, they’re pointers to our curiosity and open to further criticism.

Lidocaine and dexmedetomidine combined infusion as an alternative to propofol for sedation in colonoscopy

BackgroundColonoscopy is one of the commonly performed procedures for the diagnosis of colonic disorders. Several sedation regimens are administered during colonoscopy. To date, the propofol-based sedation regimen is commonly used, although it may have some risks. I studied the efficacy of dexmedetomidine–lidocaine combination as a substitution for propofol for sedation in colonoscopy procedures.It is a prospective randomized controlled study; 62 patients were recruited and divided into two equal groups: group P is the propofol group which included patients who received sedation with IV propofol using a loading dose of 50–100 mg of propofol and were continued on propofol IV infusion 25–75 μg/kg/min and group D-L is the dexmedetomidine–lidocaine group where patients received a loading dose of dexmedetomidine 1 μg/kg infused over 10 min followed by infusion of dexmedetomidine 0.2–0.7 μg/kg/h and lidocaine 1 mg/kg IV followed by an infusion of 1.5 mg/kg/h. The primary outcome was the median patients’ satisfaction scores after recovery assessed by the Likert 5-item scoring system. Other outcomes included postprocedure pain score, mean arterial blood pressure, saturation, heart rate during the procedure, amount of fentanyl and midazolam used during the procedure, and the number of apneic attacks.ResultsPatients in both groups were satisfied by the procedure, and the median and 1st–3rd IQ satisfaction scores were 5 (4.0–5.0) in group P and 4 (4.0–5.0) in group D-L; however, this difference was statistically significant (P value = 0.014), reflecting more satisfaction in patients who received propofol. Patients in group D-L required significantly more doses of midazolam and fentanyl to achieve an adequate sedation score, had a more significant drop in heart rate, and had significantly more postoperative pain scores than those in group P. Patients in group P had significantly more apneic attacks and lower intraprocedural oxygen saturation levels than those in group D-L.ConclusionDexmedetomidine–lidocaine combined IV infusion was found to be effective and safe for sedation in colonoscopy with less side effects in terms of apneic attacks and desaturation, although patient satisfaction was significantly higher in the propofol group, yet as per the sedation scores this was considered to be clinically non-significant.Trial registrationThe study was registered by the Australian New Zealand Clinical Trials Registry (trial ID: 12620000249954).

Correction to: The Therapy of Congenital Myasthenic Syndromes.

The third paragraph in the left column of page 256 of the article pertaining to the treatment of congenital choline acetyl transferase (ChAT) deficiency states that "Because apneic attacks occur suddenly in infants and children, the parents should be provided with an inflatable rescue bag."

Anesthetic management of a Rett syndrome patient with apnea and epilepsy: a case report

Rett syndrome, which is a progressive, central nervous system disease that is caused by a gene mutation, is known to present with various symptoms. This case is that of a 15-year-old girl who was diagnosed with Rett syndrome at the age of 2 years. Laryngotracheal isolation under general anesthesia was planned due to recurrent aspiration pneumonia. Since the patient’s nutritional status and control of convulsions were good, this was deemed an appropriate time for the surgery. Following careful preoperative evaluation of her airway, we performed oral endotracheal intubation using a video laryngoscope after rapid induction. Since postoperative pain control was important to prevent apneic attacks and convulsions, we used a multimodal analgesic regimen including carefully titrated fentanyl, acetaminophen, nonsteroidal anti-inflammatory drug, and wound infiltration with a local anesthetic. Postoperatively, the patient returned to the intensive care unit under spontaneous ventilation and followed a good course. Patients with Rett syndrome present several symptoms. Thus, several points must be considered during the preoperative evaluation, anesthetic management, and postoperative care of these patients.

Cor pulmonale in an unusual case of obstructive adenoid enlargement

Enlargement and infection of the adenoids and tonsils are associated with problems of otitis media, sinusitis, obstructive sleep disordered breathing, and alterations of facial growth. In addition, they may also lead to cardiopulmonary disorders in children. This report aims to highlight the cardiopulmonary sequelae in a child with obstructive adenoid enlargement and temporomandibular joint ankylosis in our practice. The child presented at 6 years of age with complaints of noisy breathing, blocked nose, mouth breathing, and loud snoring. Her condition deteriorated with frequent apneic attacks, easy fatigability, and swelling of the legs. The blood pressure was 100/60 mmHg, the jugular venous pressure was elevated, with displaced apex beat at the sixth left intercostal space, anterior axillary line, with parasternal heave. There were first and second heart sounds with a loud P2. The findings on electrocardiogram and echocardiogram confirmed a diagnosis of cor pulmonale secondary to severe obstructive adenotonsillar disease. A flexible nasopharyngoscopy revealed a bilateral grade IV adenoidal obstruction of the choanae. She was managed for heart failure and had emergency tracheostomy. Subsequently, she had endoscopic transnasal microdebrider-assisted adenoidectomy. She has improved remarkably and on follow-ups at the ENT, pediatric, and MFU clinics. In conclusion, pulmonary hypertension and cor pulmonale, even though rare, are possible complications of untreated adenotonsillar hypertrophy in children.

Severe Neonatal Presentation of Mitochondrial Citrate Carrier (SLC25A1) Deficiency.

Mutations of the mitochondrial citrate carrier (CIC) SLC25A1 cause combined D-2- and L-2-hydroxyglutaric aciduria (DL-2HGA; OMIM #615182), a neurometabolic disorder characterized by developmental delay, hypotonia, and seizures. Here, we describe the female child of consanguineous parents who presented neonatally with lactic acidosis, periventricular frontal lobe cysts, facial dysmorphism, recurrent apneic episodes, and deficient complex IV (cytochrome c oxidase) activity in skeletal muscle. Exome sequencing revealed a homozygous SLC25A1 missense mutation [NM_005984.4: c.593G>A; p.(Arg198His)] of a ubiquitously conserved arginine residue putatively situated within the substrate-binding site I of CIC. Retrospective review of the patient's organic acids confirmed the D- and L-2-hydroxyglutaric aciduria typical of DL-2HGA to be present, although this was not appreciated on initial presentation. Cultured patient skin fibroblasts showed reduced survival in culture, diminished mitochondrial spare respiratory capacity, increased glycolytic flux, and normal mitochondrial bulk, inner membrane potential, and network morphology. Neither cell survival nor cellular respiratory parameters were improved by citrate supplementation, although oral citrate supplementation did coincide with amelioration of lactic acidosis and apneic attacks in the patient. This is the fifth clinical report of CIC deficiency to date. The clinical features in our patient suggest that this disorder, which can potentially be recognized either by molecular means or based on its characteristic organic aciduria, should be considered in the differential diagnosis of pyruvate dehydrogenase deficiency and respiratory chain disorders. One-Sentence Summary A novel homozygous missense substitution in SLC25A1 was identified in a neonate presenting with lactic acidosis, intracerebral cysts, and an apparent mitochondrial complex IV defect in muscle.

Predictors of poor outcome in neonates with respiratory distress

Background: To identify the determinants of mortality in neonates admitted in sncu of tertiary care hospital with respiratory distress. Neonatal intensive care unit in a tertiary level care hospital in central India. Study Design was a prospective observational study. Neonates admitted with respiratory distress over a period of 8 months. Methods: Neonates with respiratory distress i.e. respiratory rate >60/min, chest retraction, grunting, central cyanosis, were included in the study. Surgical problems causing respiratory distress i.e., congenital malformations affecting respiratory tract and congenital heart disease were excluded from the study. All the cases were divided in two groups based on outcome with good outcome defined as those babies who were discharged and poor outcome defined as those babies who expired during the treatment and analyzed . Results: On analysis, Antenatal history of per vaginal bleed, meconium stained liquor, prolonged rupture of membrane, VLBW, prematurity, pre-ductal SpO 2 , shock, apneic attacks, positive sepsis screen were found to be significantly associated with death. Conclusions: India in recent times has made huge improvement in neonatal care with establishing special care new born units. But, still the neonatal mortality rate is in higher range and needs further intense approach to reduce it. The antenatal and neonatal factors discussed above can be used as referral criteria for early referral of a new born with respiratory distress to a tertiary level new born unit for further management. The early identification and referral of a neonate with above risk factors may help in reducing the associated mortality and hence will reduce neonatal mortality.

Clinical pharmacology of theophylline in preterm infants: effects, metabolism and pharmacokinetics.

Recurrent apnea is common in preterm infants with consequent episodes of loss of effective breathing and the bronchodilator theophylline prevents apnea and reduces the number of apneic attacks. This drug also reduces hypoxaemic episodes. Theophylline acts on the lungs, kidneys and brain. Theophylline inhibits solute reabsorption in various segments of the nephron and a marked diuresis which occurs immediately after the administration of theophylline. This drug ameliorates kidney dysfunction and prophylaxis given early after birth, preventing vasomotor nephropathy. Theophylline reduces brain activity and reduces the spontaneous activity transients and alters the sleep-wake state in pre-term infants. Theophylline is extensively metabolized in premature infants and its major metabolic product is caffeine. The demethylation pathway occurring predominantly in adults is substituted by N-methylation to caffeine in premature infants. The halflife of theophylline is 5-fold longer in neonates than in adults and reaches the adult value at the age of 55 weeks. Theophylline may be administered trans-cutaneously by applying this drug to the back or abdomen of the infants and the mean fractional absorbance at 30 hours is 0.25. Theophylline is present in saliva and the concentration of this drug in saliva is similar to that in plasma, saliva may be used to monitor theophylline concentration. In conclusion, theophylline is a useful drug to treat apnea and ameliorate kidney dysfunction.

Diagnosis and Outcome of SCN4A-Related Severe Neonatal Episodic Laryngospasm (SNEL): 2 New Cases

Mutations of SCN4A encoding the skeletal muscle sodium channel Nav 1.4 cause several types of disease, including sodium channel myotonias. The latter may be responsible for neonatal symptoms, including severe neonatal episodic laryngospasm (SNEL). Establishing the diagnosis of SCN4A-related SNEL early in the neonatal period is crucial because treatment is available that can reduce laryngospasm and improve vital and cerebral outcome. We report 2 new unrelated French patients who presented with SNEL. The first patient was initially diagnosed with laryngomalacia and underwent laryngeal surgery in the neonatal period before being diagnosed with myotonia at 14 months of age. The episodes of laryngospasm disappeared spontaneously, although occasional circumstances such as cold exposure could trigger laryngeal reactions; in addition, he developed myotonia corresponding to an adult myotonia permanens phenotype. This patient is now 24 years old and leading a normal life. The second patient was initially diagnosed with gastroesophageal reflux, then SNEL; his condition improved with carbamazepine treatment, and he is now 6 months old. The diagnostic sequence in both patients was the same: first, severe episodic apneic attacks necessitating hospitalization occurring in the first week of life; second, observation of muscle hypertrophy and peripheral hypertonia with a clear myotonic pattern on electromyogram (at 14 and 3 months of age, respectively); third, genetic testing revealing de novo SCN4A G1306E mutation. Both patients have had good therapeutic response to sodium channel blockers (carbamazepine or mexiletine).

Use of Buspirone and Fluoxetine for Breathing Problems in Rett Syndrome

Rett syndrome is a severe neurodevelopmental disease with a prevalence of 0.88 per 10,000 girls aged 5-18 years, and is often caused by mutations in methyl-cytosine-phosphate-guanine (CpG)-binding protein 2. Disorder of respiratory control is a prominent feature of Rett syndrome. Brainstem serotoninergic neurons are known to play an important role in the arrangement of breathing rhythm and pattern. We present a patient whose severe hyperventilation and apneic attacks resolved with the concomitant treatment of fluoxetine and buspirone. To our knowledge, we describe the first patient with Rett syndrome to receive fluoxetine for respiratory problems.

Impact of Skin to Skin Care, Prone and Supine Positioning on Cardiorespiratory Parameters and Thermoregulation in Premature Infants

Background: Skin to skin care (SSC), prone (PP) and supine (SP) positions are standard positions in daily care for premature infants. Their influence on cardiorespiratory parameters and thermoregulation is discussed controversially. Objectives: We compared SSC with PP, the recommended position for preterm infants, and SP, the safest position for term infants, and tested the hypothesis that SSC has no impact on cardiorespiratory parameters and thermoregulation. Methods: In 18 spontaneously breathing premature infants [median gestational 28 weeks (24–32); chronological age 36 days (7–64), and weight 1,543 g (750–2,100)], heart and respiratory rate, breathing pattern, episodes of desaturation (<85 but ≧80 and <80%), oxygen saturation and rectal temperature were analyzed with polygraphy (Alice 3® and 3.5®) in a 6-hour measuring cycle of three subsequent series (120 min each in SP, SSC and PP) and compared (Wilcoxon test). Results: During SSC, we found no increase in apneic attacks and bradycardic episodes and no difference in respiratory rate, breathing pattern, oxygen saturation, episodes and duration of desaturation compared to SP and PP. Episodes of desaturation <85 but ≧80 and <80% were more frequent in SP compared to PP (p = 0.0421 and p = 0.0319). Heart rate increased in SSC and PP compared to SP (154.86 bpm, SD 11.55, and 153.33 bpm, SD 15.95 vs. 150.25 bpm, SD 14.64; p = 0.0013 and p = 0.0346). Temperature level was not significantly higher during SSC and PP compared to SP except a rise between the start and the end of the 6-hour measuring cycle (37.05°C, SD 0.2 vs. 37.30°C, SD 0.3; p = 0.0436). Conclusion: We found no significant SSC-mediated changes in quality and quantity of desaturations and in body temperature compared to PP in preterm infants.

P079 Myopathic electromyography, Diazepam responsive apneic attacks and congenital myasthenic syndrome

P079 Myopathic electromyography, Diazepam responsive apneic attacks and congenital myasthenic syndrome

Temporary Diazepam Responsive Apneic Attacks and Congenital Myasthenic Syndrome

Congenital myasthenic syndromes are a genetically and phenotypically heterogeneous group of hereditary disorders affecting neuromuscular junction. Mutations in the gene encoding choline acetyltransferase cause presynaptic defects. The missense mutation I336T has been identified in Turkish population, and most of the cases carrying this mutation present with exercise-induced fatigability and ptosis. Although apneic attacks occur in these cases during febrile illness in childhood, the number of reported respiratory distress episodes during infancy is scarce. Another important feature of these cases is that response to esterase inhibitors is satisfactory. We present a case of congenital myasthenic syndrome with I336T choline acetyltransferase mutation who presented with numerous attacks of respiratory distress in the infancy period. Interestingly, the patient had myopathic findings on electromyography and diazepam decreased severity of apneic attacks. There was also no improvement with esterase inhibitors.

Traitement des apnées idiopathiques du prématuré par stimulations sensorielles

Idiopathic apneas of prematurity remain an alarming problem in neonatology. Long-term effects on neurological development cannot be excluded. Two principal treatments are currently applied to prevent apneic attacks: analeptics (methylxanthines and doxapram) and continuous positive airway pressure. Several studies suggest the use of sensory stimulations for curative or preventive treatments. Protocols of tactile, kinesthetic and auditory stimulations are described and their respective efficacy is discussed. We also resume a recent preliminary study which suggested the use of an olfactory stimulation as preventive treatment. A beneficial effect, specifically on apnea associated with severe bradycardia, was observed. Complementary studies are necessary to confirm the benefit of such sensory stimulations for apneas of prematurity, and, if so, to allow clinical applications.

Free Communications: Genetics

Abstract *SumimasaYamashita, *HirokoIwamoto, *MichikoYamada, *MizueIai, *KaoriMasuko, *KazuyoWakabayashi, and †KenjiSugai *Kanagawa Children's Medical Center, Division of Child Neurology, Yokohama ; and †National Center of Neurology and Psychiatry, Musashi Hospital, Division of Child Neurology, Kodaira, Japan. Purpose: We encountered four cases of early myoclonic encephalopathy, consisting of two sets of siblings in two families. In family S, the elder sister is 7 years old now, severely handicapped and demonstrating both uncontrolled myoclonic and short tonic seizures as well as severe hepatic cirrhosis. The younger brother died at age 9 months. In another family O, the elder sister died at age 1 year, and the younger sister died at age 3 months. Each pregnancy was normal, and the deliveries were term, and all infants showed normal birth weight and normal head circumference. None of the infants was severely asphyxiated. Methods: The clinical record of these four cases revealed that the first seizure commenced within 1.5 months after birth, and seizure types were tonic spasms and myoclonic and clonic seizures. A suppression burst pattern was found in all cases at the beginning and then changed to focal or multifocal abnormalities thereafter. None of the cases showed hypsarrhythmia on EEG. In family S, both cases had minor anomalies such as characteristic facial appearances and finger overlapping. Results: Brain MRI showed severe brain atrophy in all cases but none of the cases showed cortical dysgenesis. In family O, the elder sister showed progressive cerebral and cerebellar atrophy, and the younger sister showed myelinating arrest of the cerebral white matter. Developmental milestones were arrested since the neonatal period in four cases. All cases had severe microcephalus, spastic tetraplegia, and severe mental retardation. Laboratory examination revealed no abnormal findings including CBC, chemistry, lactate, pyruvate, amino acids analysis, organic acids analysis, lysosomal enzymes assay using white blood cells, cerebrospinal fluid examination, and urinalysis. Chromosomal study was normal in all cases. Anticonvulsants such as oral high-dose phenobarbital, intravenous phenytoin for focal onset seizures, and zonisamide for apneic attacks were all effective to a moderate extent in some cases but did not reach complete seizure control. Autopsies were performed in two cases. Severe gliosis of cerebral white matter and marked dendritic expansions of cerebellar Purkinje cells were seen in both cases. No storage materials of neuronal and glial cells or laminar structural abnormalities of the cerebral cortex were found. Conclusions: It is important to differentiate from early infantile epileptic encephalopathy, which is characterized by severe asphyxia, brain anomaly, or cortical dysgenesis as a cause, tonic spasm in the seizure pattern of the onset, and alteration to West syndrome. Our cases did not fulfill these points. The main type of seizure was myoclonic or erratic myoclonia. Early myoclonic encephalopathy (EME) is known in cases of nonketotic hyperglycinemia or other inherited metabolic disorders as a cause of the disease. We could not detect metabolic abnormalities in the cases described. However, EME was suspected to have developed because of some genetic factors that might have influenced the development of the infantile nervous system.

The Effect of Positioning on the Severity Of Sleep Apnea Syndrome and Its Relevance In the Avoidance of Hypoxia in Acute Stroke

The aim of the current systematic review was to investigate the effect of positioning on the severity of sleep apnea syndrome (SAS), in order to identify which subjects will show this effect and to establish the efficacy of positioning as a treatment. Databases searched were: Premedline and Medline, Psychinfo, Embase, CINAHL, PEDro, all EMB Reviews and the Scottish Intercollegiate Guidelines Network plus hand searching. All study types, except case studies, were included and the methodological quality was evaluated using a tool designed by Downes and Black. Twenty papers were included. Taken together they suggested that less obese SAS patients have fewer apneic attacks when sleeping on their side and very obese patients when sleeping sitting up. Treatments that avoid supine lying reduce the incidence of apneic attacks, and positioning may be useful in avoiding hypoxaemia in stroke. Generally the papers were of poor quality, thus highlighting the need for further studies.

Evaluation of change of cerebral circulation by SpO2 in preterm infants with apneic episodes using near infrared spectroscopy.

In the neonatal intensive care unit (NICU), hemodynamics in very low-birthweight infants are generally examined for oxygen saturation (SpO2), heart rate, respiration rate, and blood pressure. The present study examined how changes in cerebral circulation in preterm infants can be evaluated by the SpO2 monitoring method with near infrared spectroscopy (NIRS) to detect the cerebral circulation. The study was conducted in 11 low-birthweight neonates with a mean weight of 1252 g (940-1948 g), mean post-conceptional age of 28.9 weeks (28-31 weeks) and in whom a total of 145 apneic episodes were examined. Changes in cerebral circulation at the apneic attack were evaluated by two parameters of Delta HbD ( micro mol/L) for reduction in cerebral oxygenation and Delta cHb (mL/100 g brain) for variation in cerebral blood volume using the near infrared spectroscopy (NIRS). There was a tendency for a reduction in cerebral oxygenation and a change in cerebral blood volume as SpO2 was reduced. In the event of apneic attacks where SpO2 was reduced to <85%, cerebral oxygen saturation was extensively reduced. In addition, cerebral blood volume was also greatly changed when the SpO2 was reduced to <85%, and changed further still when SpO2 was reduced again to < or =75%. Reduction in SpO2 (<85%) was suggested to be an effective indication to changes in cerebral circulation. In the case of apneic attacks where SpO2 was < or =85%, the cerebral circulation in preterm low-birthweight neonates was extensively changed and, therefore, attention should be paid to changes in the concentration of SpO2 when managing apnea of prematurity in NICU.

Historical Perspectives

I trained in pediatric respiratory medicine and cardiology in Oxford and Liverpool. When I was appointed a Consultant Pediatrician, I continued to research and expand my interest in these specialties further. At the time (1968 to 1970), we studied the treatment of asthma in toddlers by using aminophylline suppositories. With the use of 10 to 20 mg/kg per day of aminophylline, suppositories resulted in beneficial clinical responses and serum levels of 10 to 20 mcg/mL. More importantly, no serious adverse effects were observed. During these years, the duties of a Consultant Pediatrician in the United Kingdom included the care of the newborn and supervision of the special care baby unit at the local maternity hospital. The total number of babies born in my local hospital was about 3,000 per year. During 1969, a preterm baby in the special care unit developed numerous apneic attacks that lasted 30 seconds or longer and were associated with periods of bradycardia and hypoxia. Although ventilatory support was useful in managing each severe episode, the attacks resumed as soon as the ventilatory support was withdrawn. Other means, such as external stimulation or increasing the ambient oxygen concentrations, were unsuccessful in prevented subsequent apnea. Sadly, the baby, whose birthweight was 1,205 g, died 18 days after birth. At the postmortem examination, a small intraventricular hemorrhage was found in addition to some evidence of hypoxic damage …

Pasteurella gallinarum neonatal meningitis

A 4-day-old baby weighing 1.7 kg was admitted to the neonatal intensive care unit of Ga-Rankuwa Hospital, Pretoria, with a history of apneic attacks. On examination there was an umbilical sepsis and the neonate was septicemic. The baby had been delivered at home and the umbilical cord had been cut by the grandmother using unclean scissors and chimney soot applied to the umbilical stump. On admission, a septic screen was done and antibiotic treatment was started with penicillin and amikacin. The investigations showed that the baby was slightly anemic, with hemoglobin levels of 10.0 g/dL (14.9-23.7 g/dL), and a pure growth of a Gram-negative bacillus was obtained from the cerebrospinal fluid, blood culture and suprapubic aspirate urine specimens. The Gram-negative bacillus was catalase and oxidase positive and it was identified as Pasteurella gallinarum. Antimicrobial profiling showed the organism to be susceptible to penicillin, cefotaxime, gentamicin and amikacin. Despite having received antimicrobial agents to which the etiological agent was susceptible, the neonate died within 5 days of admission. The cause of death was postulated to be due to overwhelming sepsis which resulted in septic shock.

Aortopexy in esophageal atresia: Long-term experience of a parent support group

Purpose: The aim of this study was to obtain the parents' view of aortopexy after esophageal atresia. Methods: A questionnaire was completed by the parents of 24 former patients, now aged from 1 to 15 years (average, 8.9; median, 9.0 years). The respondents were all members of a support group. Results: The median age of the patients receiving aortopexy was 4 months. The 24 procedures were performed in 16 different hospitals. The subjects had experienced a median of 3 apneic attacks. Technical complications occurred in 4 of the 24 children. In 71%, aortopexy was an immediate success. Conclusion: Despite its low success rate compared with centers with large cumulative experience, 90% of parents were satisfied with the result. J Pediatr Surg 36:1502-1503. Copyright © 2001 by W.B. Saunders Company.