LIFE-THREATENING INFANTILE APNEA - RESULTS OF PRIMARY EVALUATION AND LONG-TERM FOLLOW-UP

Abstract

Management of the infant with severe infantile apnea remains controversial. Studies have suggested that home cardiorespiratory monitoring failed to prevent subsequent deaths from SIDS in as many as 10% of patients. In order to assess the effectiveness of home cardiorespiratory monitoring upon subsequent outcome in severe infantile apnea, 32 infants were evaluated and prospectively followed. These infants represented 8%(32/396) of the children seen at the Children's Hospital of Philadelphia during a two year period. All 32 infants had life-threatening apnea requiring cardiopulmonary resuscitation by parents, physicians, or paramedical personnel. Twenty-five (78.1%) were term infants, 7 (21.9%) were pre-term babies. Mean ± SEM G.A. at birth was 37.9 ± 0.3 wks. Age at the time of initial apneic episode was 8.6 ± 1.3 wks. Initial thermistor-pneumocardiogram evaluation revealed respiratory pattern abnormalities in 16 (50%) infants: central apnea - 5 (15.6%); obstructive apnea - 1 (3.2%); periodic breathing - 6 (18.7%); gastroesophageal reflux associated apnea - 4 (12.5%). All infants were treated with home cardiorespiratory monitoring. Mean ± SEM duration of monitoring was 4.7 ± 0.5 months. Ten infants (31.3%) had apnea while monitored which required vigorous stimulation. Two infants (6.25%) required vigorous stimulation including CPR. Infants have been followed for a mean of 21.3 ± 6.3 SEM months. No deaths have occurred. These results suggest that one-third of infants with severe infantile apnea will have subsequent respiratory episodes at home. Home monitoring appears to be an effective therapy in this group of babies at highest risk for continuing apnea.

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