[Growth retardation and obstructive sleep apnea in infants]

Obstructive sleep apnea can induce growth retardation, with cardiac and/or neurologic manifestations. Tonsillectomy and adenoidectomy may improve failure to thrive.

Case n. 1: A 11 1/2-month-old boy was admitted because of feeding problems plus chronic nasopharyngeal secretions (eventually purulent) since the first months of life. He showed a low rate of weight gain since the age of 7 months and had been treated treated for gastroesophageal reflux for a few weeks. On admission, his weight was 6,220 g and his height was 70.5 cm. The tonsils were enlarged and the uvula was long. He displayed tachycardia (150/min). Polygraphic recordings during sleep showed numerous episodes of obstructive apnea. Arterial oxygen saturation (SaO2) during the night was low, frequently below 80%. Tonsillectomy and adenoidectomy immediately improved the quality of sleep. Nocturnal SaO2 and cardiac rythm improved one week later; there was a catch-up weight one month after surgery. Case n. 2: A 7-month-old boy, was admitted because chronic manifestations similar to those of case n. 1. His weight was 5,900 g and his height was 67.5 cm. He also had enlarged tonsils. He suffered from episodes of snoring and obstructive sleep apnea followed by waking and sweating. PaO2 was 70 mmHg and PaCO2 was 48 mmHg. Nocturnal SaO2 was frequently below 60%. Tonsillectomy and adenoidectomy resulted in a net improvement in sleep and weight, despite persistent episodes of nocturnal hypoxemia.

Chronic hypertrophic tonsils and adenoids can interfere with weight gain. Growth retardation may dramatically improve after surgery, even if the tonsils and adenoids do not completely obstruct the nasopharynx.