Apnea, Pediatric

Basics

Description

  • Absence of respiratory airflow for a period of 20 s, with or without decreased heart rate:
    • Central apnea:
      • Disruption in the generation or propagation of respiratory signals in the brainstem and descending neuromuscular pathways
    • Obstructive apnea:
      • Respiratory effort is present, but there is no airflow
      • Structural airway obstruction, often with paradoxical chest wall movement
      • Functional obstruction from airway collapse
    • Mixed
  • Brief resolved unexplained events (BRUE):
    • Episode in an infant <1 yr that is sudden, brief, and now resolved and associated with 1 or more of the following:
      • Cyanosis or pallor
      • Absent, decreased, or irregular breathing
      • Marked change in tone
      • Altered level of responsiveness
      • A clinical presentation and diagnosis of exclusion after appropriate history and physical exam
    • Low-risk criteria:
      • Age >60 d
      • Born >32 wk or >45 wk corrected gestation
      • No CPR by trained provider
      • Event <1 min
      • First and isolated event
      • No concerning historical/PE findings
    • High-risk criteria:
      • Persistent symptoms at presentation (toxic, lethargic, recurrent vomiting, resp distress)
      • Resuscitation/CPR required
      • Bruising or signs of trauma
      • Hx of BRUE or clustered episodes
      • Hx of unexplained death in sibling
      • Dysmorphic features, known syndrome, congenital anomalies

Etiology

  • Infection:
    • Sepsis
    • Pertussis
    • Viral resp infections (including RSV)
    • Meningitis or encephalitis
    • Pneumonia
  • Respiratory:
    • Obstructive airway lesions:
      • Enlarged tonsils and adenoids
      • Vocal cord dysfunction
      • Laryngotracheomalacia
      • Vascular ring
      • Foreign body
      • Craniofacial abnormality
      • Choanal atresia or stenosis
    • Functional obstruction from airway collapse
    • Infection
    • Immaturity/prematurity
    • Abnormal ventilatory response to hypoxia/hypercarbia
  • Neurologic:
    • Seizure
    • Intracranial hemorrhage
    • Increased intracranial pressure
    • Tumor
    • Arnold–Chiari or other CNS malformation
    • Ingestion
    • Toxin
    • Carbon monoxide
    • Hypoxic injury
    • Neuromuscular disorder
    • Central hypoventilation syndrome
  • Cardiac:
    • Dysrhythmia
    • Congenital heart disease
    • CHF
    • Myocarditis
    • Cardiomyopathy
  • GI:
    • GERD
    • Volvulus
    • Intussusception
  • Child abuse
  • Endocrine/metabolic:
    • Hypoglycemia
    • Electrolyte disorders
    • Inborn errors of metabolism
  • Other:
    • Transient choking episode
    • Laryngospasm
    • Periodic breathing
    • Breath-holding spell

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