The dreaded desaturating baby: a difficult problem in clinical management

There are various causes for frequent desaturations in infants. Frequent hypoxemia is a significant change in clinical status and must be investigated carefully for possible etiology. When common extra-airway causes for desaturation are ruled out, one should attempt to distinguish between central apnea and obstructive events. The most commonly overlooked obstructive event is tracheobronchomalacia, and steps should be initiated to understand the scope of the problem through pulmonary function testing and bronchoscopy. Adequate respiratory support for the infant should be provided until adequate time passes to enable airway growth and improved cartilaginous deposition to occur. Parents must be carefully supported during this time; the stress of having an infant who requires prolonged hospitalization and care for tracheobronchomalacia is substantial.