Pediatric Apnea Workup

Updated: Feb 13, 2018
  • Author: Joshua A Rocker, MD; Chief Editor: Kirsten A Bechtel, MD  more...
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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. [25]

  • 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.

Imaging Studies

See the list below:

  • 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.

Other Tests

See the list below:

  • 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