1624 5 YEAR EXPERIENCE WITH INFANTS REFERRED FOR APNEA/ CYANOSIS

The recognition that apnea may be a possible mechanism for sudden infant death syndrome (SIDS) has led to increasing concern regarding the evaluation and management of infants who present

with a history of “apnea.” Apnea has recently been defined as a respiratory pause lasting for 20 sec or longer or a shorter episode leading to cyanosis and bradycardia. The presenting event

is most often witnessed by only the parents. Over the past 5 years, we have had 308 infants referred for respiratory related problems during the 1st year of life. The most frequent referral

diagnosis was unexplained apnea and/or cyanosis. After extensive medical evaluation there was no diagnosis to explain the event and 173 infants (25% preterms and 75% terms) were considered

“near miss for SIDS.” In 10% of these infants, a potential cause was found to explain the presenting event. In 67% of the patients there was a second event within 8 wks of the presenting

episode. Thirty-one percent of patients had a documented recurrence of apnea in the hospital. In 142 patients (83%) a home apnea/cardiac monitor was recommended. The duration of home

monitoring was from 1-18 mos. with a mean of 5 mos. The most common criterium for discontinuing monitoring was an apnea-free period of 1-2 mos. as reported by the parents. In the past 5

years, we have had 1 mortality and this infant was never managed on a monitor. Infants who present for evaluation of apnea are a heterogeneous group and home apnea/cardiac monitoring is

helpful in the management of these patients.

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