Pediatric Apnea Treatment & Management

Updated: Sep 28, 2018
  • Author: Joshua A Rocker, MD; Chief Editor: Kirsten A Bechtel, MD  more...
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Treatment

Prehospital Care

See the list below:

  • 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, O 2 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, or gentle thumping of 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 considered if a long transport time is foreseen, the apneic event is prolonged, or hypoventilation or poor respiratory effort follows.
  • 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.
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Emergency Department Care

See the list below:

  • 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 fluid resuscitation and 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.
  • The 2016 American Academy of Pediatrics Clinical Practice Guidelines on BRUE aim to standardize the approach to evaluation and management that is based on the risk that the infant will have a repeat event or has a serious underlying disorder. An infant is determined to be either low risk or high risk based on presentation, and work up and management should be performed accordingly. [34]  
  • A feeding should be observed in the health care setting for poor feeding techniques as well as for infant feeding difficulties.
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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.
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