Pediatric Apnea Workup

  • Author: Joshua A Rocker, MD; Chief Editor: Richard G Bachur, MD   more...
 
Updated: May 7, 2012
 

Laboratory Studies

If the infant is truly afebrile and appears well, laboratory results are likely to be within the reference ranges. In a recent study, 49% of patients with apparent life-threatening event (ALTE) had positive findings on history and physical that were confirmed by subsequent testing. Twenty-one percent were diagnosed by history and physical alone with no help from other tests, and 14% were diagnosed by positive tests performed after a noncontributory history and physical examination.[23]

  • If the infant does not appear well, the following studies should be considered:
    • Rapid bedside glucose testing, as a decreased glucose level may indicate sepsis or a metabolic derangement. Hypoglycemia can be treated quickly, and if untreated, its consequences can be severely damaging. Therefore, early diagnosis is essential.
    • Complete blood count with differential
    • Blood culture
    • Complete metabolic panel: The combination of hyperkalemia and hyponatremia may be the first suggestion of congenital adrenal hyperplasia in the male infant.
    • Arterial blood gas (ABG) or venous blood gas (VBG) measurement
    • Lumbar puncture with culture
    • Urinalysis and urine culture via catheter to obtain the cleanest specimen
  • Additional studies may include the following:
    • Viral respiratory panel to look for common causes of bronchiolitis such as RSV or influenza.
    • The tests listed above help in identifying unexplained metabolic acidosis, potential sepsis, or unexplained anemia.
    • When the clinical presentation warrants, tests of the carboxyhemoglobin and methemoglobin level and screening for certain toxins (eg, opiates, benzodiazepines, barbiturates, marijuana, toxic alcohols, botulism) should be considered.
    • If the infant has a history of central apnea, he or she may have received theophylline or caffeine, which stimulates the central respiratory centers. Therefore, one would want to know the drug levels.
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Imaging Studies

  • In most cases, no imaging studies are needed.
  • In those cases in which raised intracranial pressure or intracranial injury is suspected, CT scanning of the head is indicated.
  • In premature infants, CT of the head may reveal interventricular and periventricular hemorrhages.
  • When child abuse is seriously considered, a skeletal survey should be performed.
  • Chest radiography should be performed in the presence of increased respiratory rate, abnormal findings on lung examination, or heart murmur.
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Other Tests

  • A neurologist may request an EEG.
  • Likewise, many infants will be admitted or transferred for a multichannel sleep study (see Further Inpatient Care).
  • ECG to assess for cardiac arrhythmias or cor pulmonale
  • If congenital adrenal hypoplasia is being considered, cortisol and thyroid levels
  • pH probe for evaluation of reflux
  • Fiberoptic evaluation of the larynx
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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 Medscape Reference 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.

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