25: 2-month-old male with apnea Flashcards
Causes of apnea in infants: CNS
- seizures
- breath-holding spells
- bleed, trauma, tumor or infection
causes of apnea in infants: cardiac
- bradycardia secondary to congenital heart block or long QT syndrome
- Congenital heart disease, particularly ductal-dependent lesions
causes of apnea in infants: pulm
- The m/c respiratory cause of apnea is respiratory syncytial virus (RSV) infection. Premature infants and infants younger than 2 months are at highest risk for apnea with RSV.
- Pertussis can also cause apnea, especially in infants.
- Other lower respiratory infections (e.g., viral and bacterial pneumonias)
causes of apnea in infants: GI
- Swallowing abnormalities
- Tracheoesophaeal fistula
causes of apnea in infants: systemic
- systemic sepsis
- metabolic d/o
- ingestions of meds or toxins
- botulinum toxin
- environmental exposures
Brief Resolved Unexplained Event (BRUE)
an event occurring in an infant younger than 1 year when the observer reports a sudden, brief, and now-resolved episode that includes one or more of the following:
- cyanosis or pallor
- absent, decreased, or irregular breathing
- marked change in tone (hyper- or hypotonia) -altered level of responsiveness.
Team Members in Cases of Suspected Child Abuse
- neurologist
- child advocacy doc
- ophtho
- social worker
In general, skeletal survey findings that raise suspicion for abuse include:
- -Fractures or injuries that are inconsistent with reported mechanism of injury and/or the developmental stage or abilities of the child.
- -Multiple fractures or injuries at different stages of healing
- -Fracture of the femur or tibia in a non-walking child. Note that “Toddler’s fracture” is a common injury, typically to the tibia, in young walking children. Toddler’s fracture is not a sign of abuse.
- -Posterior rib fractures, which are frequently associated w/ shaken baby syndrome due to squeezing of the thorax by the perpetrator’s hands d/r shaking.
- -Skull fracture in an infant is also very suspicious for abuse. In these cases, it is very important to discern if the mechanism of injury reported by the parent or caretaker is consistent with the injury seen. Involvement of a pediatric radiologist skilled in interpreting these films can be critical.

Prognosis for Victims of Abusive Head Trauma
Many babies with subdural hematomas and retinal hemorrhages have long-term developmental delays, seizures, and/or difficulty with vision.
head CT
highly sensitive for an intracranial bleed, such as a subdural hematoma, can be quickly carried out in the emergency setting, and may require urgent intervention
toddler’s fracture
fracture of the tibia is a commonly occurring fracture in young, ambulatory kids. It is not a sign of abuse. Toddler’s fracture is described as a subtle, non-displaced oblique fracture of the distal tibia in kids aged 9 months to 3 years. The child will usually present with acute onset of limp and refusal to bear weight on one leg. It usually occurs when a toddler falls while twisting, or gets a foot caught and falls while trying to free the foot.
patient with congenital heart disease
Typically the patient will suffer from acute decompensation within the first few weeks of life. These patients will also have growth problems, difficulty with feeding and a murmur is often appreciated on physical exam. Children with undiagnosed Tet of Fallot may have intermittent episodes of cyanosis while blood supply is diverted from the pulmonary vasculature
Closed head injuries and retinal hemorrhages in infants and children
secondary to violent shaking or throwing, resulting in tearing of the bridging vessels. Retinal hemorrhages, as seen in our patient, are pathognomonic for shaken baby syndrome. Other signs and symptoms include stiffness, constant crying, seizures, difficulty to arouse, decreased appetite and excessive sleeping. Victims often have no other signs of physical abuse (e.g., bruises).
