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Infant apnea syndrome. A prospective evaluation of etiologies
Insights
Detailed evaluation of infant apnea syndrome (IAS) often identifies a specific cause. Lumbar puncture, EEG, and esophageal pH studies were most valuable in diagnosing IAS.
Area of Science:
- Pediatrics
- Neonatology
- Neurology
Background:
- Infant apnea syndrome (IAS), or "near miss" sudden infant death, has unknown etiological frequencies.
- A systematic evaluation protocol was applied to a cohort of infants presenting with IAS.
Purpose of the Study:
- To determine the frequency of identifiable causes for infant apnea syndrome (IAS).
- To assess the diagnostic yield of various investigations in infants with IAS.
Main Methods:
- A prospective study of 28 consecutive infants with IAS was conducted.
- In-hospital evaluations included comprehensive laboratory tests, imaging (skull X-ray, chest X-ray, barium swallow), electrocardiogram, echocardiogram, Holter monitoring, microbial cultures, electroencephalogram (EEG), and esophageal pH monitoring for gastroesophageal reflux (GER).
Main Results:
- A probable cause was identified in 17 out of 28 infants (60.7%).
- Identified causes included GER (6), encephalitis (4), convulsive disorder (3), periventricular edema (1), Arnold-Chiari malformation (1), milk allergy (1), and periodic breathing (1).
- Lumbar puncture, EEG, and esophageal pH studies were found to be the most valuable diagnostic investigations.
Conclusions:
- Comprehensive diagnostic evaluation frequently leads to a specific etiology in infants with IAS.
- Early identification of causes can guide management and potentially prevent adverse outcomes.
Abstract:
The frequency of proposed causes for the infant apnea syndrome (IAS) or "near miss" sudden infant death is unknown. Using a protocol, we investigated a small series of 28 consecutive infants with IAS. This in-hospital evaluation included, for all patients, blood chemistries; x-rays of skull, lumbar puncture, chest, and barium swallow; electrocardiogram, echocardiogram, 24-hour Holter cardiac monitor; viral and bacterial cultures of blood, urine, stool, and CSF; EEG; and esophageal pH study for gastroesophageal reflux (GER). A probable cause was found in 17 of the 28 infants including GER 6, encephalitis 4, convulsive disorder 3, periventricular edema 1, Arnold-Chiari malformation 1, milk allergy 1, periodic breathing 1. Home apnea monitors were used only by three, all of whom had no diagnosis and only these three had repeat apneic episodes. There have been no deaths during follow-up of 12 to 24 months. It is our conclusion that detailed evaluation of IAS often yields a specific diagnosis. The most valuable investigations were lumbar puncture, EEG, and esophageal pH studies.