Pediatric Apnea Treatment & Management

  • Author: Joshua A Rocker, MD; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Aug 25, 2010
 

Prehospital Care

  • Prehospital care first and foremost includes resuscitation, if necessary, and prompt monitored transport to an ED.
  • If the child is cyanotic or a pulse oxygen level is low but respiratory effort is present O2 should be administered via a nonrebreather.
  • If the infant has an apneic event during transport, prehospital personnel should first attempt simple manual stimulation of the infant with brisk rubbing along the patient's back, patting, and thumping the feet. If these maneuvers fail, resuscitation via bag valve mask should be initiated immediately and securing a laryngeal mask airway (LMA) or endotracheal tube (ETT) placement may be necessary if a long transport time is foreseen.
  • If the patient is seizing, local protocols should be followed and oxygen administered.
  • If the patient is lethargic, local protocols should be followed, but, if a glucose evaluation can be performed, it should be, and hypoglycemia treated if present. If not possible, dextrose should be given prophylactically.
  • With the cyanotic child or a child with an abnormal cardiac rhythm, an AED should be placed or an ECG should be obtained. If the child is pulseless, CPR should be initiated and epinephrine given.
Next

Emergency Department Care

  • In the ED, all infants should receive cardiac and respiratory monitoring.
  • Ill-appearing infants should be treated as needed on the basis of their clinical condition. Treatment may include resuscitation or aggressive antibiotic treatment of sepsis.
  • Well-appearing infants may need no emergency treatment other than a careful history and physical examination and then some close observation.
  • A feeding should be observed in the health care setting for poor feeding techniques as well as for infant feeding difficulties.
Previous
Next

Consultations

The history, physical examination, and diagnostic workup determine which consultation may become necessary to evaluate the patient. These may include the following:

  • Pediatric gastroenterologist
  • Pediatric neurologist
  • Pediatric cardiologist
  • Pediatric endocrinologist
  • Metabolic/genetics specialist
  • Pediatric intensivist
  • Neonatologist
  • Sleep specialists
  • Otolaryngologist

The patients who are on home monitoring should have a consultation with the service that placed them on the monitor. Most children with apnea receive follow-up care by a special apnea service.

  • Such services may be helpful by providing important data about the patient's history. Also, they often facilitate contact with the company providing the monitoring service.
  • In addition, the apnea service may be able to simplify the process of admission or transfer to a tertiary care pediatric facility.
Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Joshua A Rocker, MD  Assistant Professor of Pediatrics and Emergency Medicine, Albert Einstein College of Medicine; Director of Education for Pediatrics Emergency Medicine Fellowship, Pediatrics Emergency Medicine, Cohen's Children Medical Center of New York

Joshua A Rocker, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Jeffrey Israel, MD  Pediatric Emergency Medicine Fellow, Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System

Jeffrey Israel, MD, is a member of the following medical societies: American Academy of Pediatrics and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Kirsten A Bechtel, MD  Associate Professor, Department of Pediatrics, Yale University School of Medicine; Attending Physician, Department of Pediatric Emergency Medicine, Yale-New Haven Children's Hospital

Kirsten A Bechtel, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Elizabeth B Jones, MD, Brent R King, MD, and Isaac Grate Jr, MD, to the development and writing of this article.

References

  1. Blystad W. Blood gas determinations on premature infants. III. Investigations on premature infants with recurrent attacks of apnea. Acta Paediatr. May 1956;45(3):211-21. [Medline].

  2. Miller HC, Behrle FC, Smull NW. Severe apnea and irregular respiratory rhythms among premature infants; a clinical and laboratory study. Pediatrics. Apr 1959;23(4):676-85. [Medline].

  3. Perlstein PH, Edwards NK, Sutherland JM. Apnea in premature infants and incubator-air-temperature changes. N Engl J Med. Feb 26 1970;282(9):461-6. [Medline].

  4. Nelson NM. Members of task force on prolonged apnea. Reports of the task force on prolonged apnea of the American Academy of Pediatrics. Pediatrics. 1978;61:651-652.

  5. Committee on Fetus and Newborn. American Academy of Pediatrics. Apnea, sudden infant death syndrome, and home monitoring. Pediatrics. Apr 2003;111(4 Pt 1):914-7. [Medline].

  6. Fleming P, Blair P, Bacon C, et al. Sudden unexpected deaths in Infancy: the CESDI SUDI studies 1993-1996. Stationary Office. 2000.

  7. Brooks JG. Apparent life-threatening events and apnea of infancy. Clin Perinatol. Dec 1992;19(4):809-38. [Medline].

  8. Ralston S, Hill V. Incidence of Apnea in Infants Hospitalized with Respiratory Syncytial Virus Bronchiolitis: A Systematic Review. J Pediatr. Jul 31 2009;[Medline].

  9. Genizi J, Pillar G, Ravid S, Shahar E. Apparent life-threatening events: neurological correlates and the mandatory work-up. J Child Neurol. Nov 2008;23(11):1305-7. [Medline].

  10. Dewolfe CC. Apparent life-threatening event: a review. Pediatr Clin North Am. Aug 2005;52(4):1127-46, ix. [Medline].

  11. Kiechl-Kohlendorfer U, Hof D, Peglow UP, Traweger-Ravanelli B, Kiechl S. Epidemiology of apparent life threatening events. Arch Dis Child. Mar 2005;90(3):297-300. [Medline].

  12. Kahn A, Groswasser J, Rebuffat E, et al. Sleep and cardiorespiratory characteristics of infant victims of sudden death: a prospective case-control study. Sleep. Aug 1992;15(4):287-92. [Medline].

  13. Bonkowsky JL, Guenther E, Filloux FM, Srivastava R. Death, child abuse, and adverse neurological outcome of infants after an apparent life-threatening event. Pediatrics. Jul 2008;122(1):125-31. [Medline].

  14. Henderson-Smart DJ. The effect of gestational age on the incidence and duration of recurrent apnoea in newborn babies. Aust Paediatr J. Dec 1981;17(4):273-6. [Medline].

  15. Stephan-Blanchard E, Chardon K, Leke A, Delanaud S, Djeddi D, Libert JP, et al. In utero exposure to smoking and peripheral chemoreceptor function in preterm neonates. Pediatrics. Mar 2010;125(3):e592-9. [Medline].

  16. Brand DA, Altman RL, Purtill K, Edwards KS. Yield of diagnostic testing in infants who have had an apparent life-threatening event. Pediatrics. Apr 2005;115(4):885-93. [Medline].

  17. McGinley B, Halbower A, Schwartz AR, Smith PL, Patil SP, Schneider H. Effect of a high-flow open nasal cannula system on obstructive sleep apnea in children. Pediatrics. Jul 2009;124(1):179-88. [Medline]. [Full Text].

  18. [Guideline] Atwood CW Jr, McCrory D, Garcia JG, Abman SH, Ahearn GS. Pulmonary artery hypertension and sleep-disordered breathing: ACCP evidence-based clinical practice guidelines. Chest. Jul 2004;126(1 Suppl):72S-77S. [Medline].

  19. Claudius I, Keens T. Do all infants with apparent life-threatening events need to be admitted?. Pediatrics. Apr 2007;119(4):679-83. [Medline].

  20. De Piero AD, Teach SJ, Chamberlain JM. ED evaluation of infants after an apparent life-threatening event. Am J Emerg Med. Mar 2004;22(2):83-6. [Medline].

  21. Edner A, Wennborg M, Alm B, Lagercrantz H. Why do ALTE infants not die in SIDS?. Acta Paediatr. Feb 2007;96(2):191-4. [Medline].

  22. Gray C, Davies F, Molyneux E. Apparent life-threatening events presenting to a pediatric emergency department. Pediatr Emerg Care. Jun 1999;15(3):195-9. [Medline].

  23. Hewertson J, Poets CF, Samuels MP, Boyd SG, Neville BG, Southall DP. Epileptic seizure-induced hypoxemia in infants with apparent life-threatening events. Pediatrics. Aug 1994;94(2 Pt 1):148-56. [Medline].

  24. Hunt CE, Hufford DR, Bourguignon C, Oess MA. Home documented monitoring of cardiorespiratory pattern and oxygen saturation in healthy infants. Pediatr Res. Feb 1996;39(2):216-22. [Medline].

  25. Keens TG, Ward SL. Apnea spells, sudden death, and the role of the apnea monitor. Pediatr Clin North Am. Oct 1993;40(5):897-911. [Medline].

  26. [Guideline] Kushida CA, Morgenthaler TI, Littner MR, Alessi CA, Bailey D, Coleman J Jr. Practice parameters for the treatment of snoring and Obstructive Sleep Apnea with oral appliances: an update for 2005. Sleep. Feb 1 2006;29(2):240-3. [Medline].

  27. McGovern MC, Smith MB. Causes of apparent life threatening events in infants: a systematic review. Arch Dis Child. Nov 2004;89(11):1043-8. [Medline].

  28. [Guideline] Morgenthaler TI, Kapen S, Lee-Chiong T, Alessi C, Boehlecke B, Brown T. Practice parameters for the medical therapy of obstructive sleep apnea. Sleep. Aug 1 2006;29(8):1031-5. [Medline].

  29. Southall DP, Plunkett MC, Banks MW, Falkov AF, Samuels MP. Covert video recordings of life-threatening child abuse: lessons for child protection. Pediatrics. Nov 1997;100(5):735-60. [Medline].

  30. Spitzer AR, Gibson E. Home monitoring. Clin Perinatol. Dec 1992;19(4):907-26. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.