Pediatric emergency medicine trisk 0403 0403

TABLE 14.5
HISTORICAL FEATURES OF APNEA
History

Significant apnea

Duration of event

Greater than 20 sec or of any duration
associated with pallor, cyanosis, and/or
bradycardia
Either, but apnea during sleep is more
worrisome
Pallor or cyanosis
Seizure activity
Hypotonia, hypertonia
“He/she looked dead”
Color change or hypotonia requiring
cardiopulmonary resuscitation to improve
If shortly after feeding, consider
gastroesophageal reflux
Association with sleep, trauma

Was child asleep or awake?
Color change
Associated movements,
posture, or change in tone
Resuscitative efforts and
response
Interval since last feeding
Where event occurred

In many cases, the description of the event may be concerning, although the
child appears well. In this situation, hospitalization for further workup, as
outlined next, is warranted. A typical case might be the previously well 5-weekold child who was noted by the parents to be apneic during a nap. The infant was
described as limp and blue and “looked like he was dead.” There was no response
to tactile or verbal stimulation for 5 to 10 seconds, but after 15 to 20 seconds of
mouth-to-mouth breathing, the child coughed, gagged, and began to breathe. His
color improved over the next 30 seconds, and the parents rushed him to the
emergency department (ED). Although the baby now looks entirely normal, he
may be at grave risk for experiencing another episode of apnea.
The medical history also may provide important information regarding infants
at risk for significant or recurrent apnea. The physician should ask specifically
about previous similar episodes. Information about prenatal and perinatal events,
including gestational age, birth weight, labor and delivery issues, maternal health
and medication exposures, and nursery course, is helpful. A family history with
specific reference to seizures, infant deaths, and serious illnesses in young family
members also should be included. Information regarding medications, including