Pediatric Apnea Workup

Updated: Jan 16, 2015
  • Author: Joshua A Rocker, MD; Chief Editor: Kirsten A Bechtel, MD  more...
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Workup

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. [24]

  • 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

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.
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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
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