Apnea, SIDS, ALTE/BRUE

Question 1

Definition of Apnea

Answer 1

Pause in breathing for greater than 20 seconds
Or
Respiratory pause associated with bradycardia or oxygen desaturation

Question 2

Differentiate Apnea of Prematurity vs Apnea of Infancy

Answer 2

Apnea of infancy
- occurs after the baby has reached 37 weeks gestation

Apnea of prematurity
- related to the underdeveloped respiratory and neurological systems

Question 3

Differentiate obstructive apnea vs central apnea?

Answer 3

Obstructive
- due to obstruction of the upper airway

Central

• dysfunction of the neurological centers that regulate breathing
• respiratory efforts complete cease

Mixed apnea
- when central and obstructive components are present

Question 4

What is periodic breathing?

Answer 4

A short respiratory pause followed by an increase in respiratory rate
Normal patterns in infants
Not cyanotic or plethoritc during these episodes

Question 5

Name 4 factors or types of factors that contribute to apnea in young infants?

Answer 5

Hypoxic Drive
Effects of feeding
Metabolic abnormalities
Mechanical factors

Hypoxic Drive
- hypoxia results in brief increase in RR then decrease in RR/apnea, mild hypoxia during sleep can lead to periodic breathing, which may not arouse the baby

Effects of feeding

• Difficulty with coordination of sucking and breathing can result in hypoxemia
• regurgitation can cause accentuated laryngeal chemoreflex which can cause apnea and bradycardia

Metabolic abnormalities
- Hypoglycemia or anemia can cause apnea

Mechanical factors
- Pliable thoracic cage, fatiguability of the diaphragmatic muscle, attempts to increase MV by increasing tidal volume can increase WOB - thus infant in resp distress can be susceptible to apnea

Question 6

Underlying cause of apnea

Answer 6

CNS: Seizure, Breath-holding
Infection: Meningitis, Bronchiolitis, Sepsis, Croup, Infant botulism, Pertussis
Cardiac: Arrhythmia
GI: GERD
Metabolic: Hypoglycemia, Inborn errors of metabolism, Toxin (ingestion)
Trauma: Accidental or inflicted head or blunt abdominal trauma
Prematurity
Idiopathic/Unknown cause

Question 7

Define SIDS

Answer 7

The sudden death of an infant < 1 year that remains unexplained after a thorough case investigation, including a complete autopsy, exam of the death scene, and review of the clinical history

Key points on SIDS:

• SIDS requires a thorough Ix including an autopsy and exam of the death scene
• Placing babies in the supine sleeping position has decreased the incidence of SIDS
• An ALTE/BRUE is not predictive of SIDS
• Home monitoring after an ALTE does not decrease the incidence of SIDS

Question 8

What is SID vs SUID

Answer 8

SUID is sudden UNexplained infant death

SIDS can be explained sometimes by ingestion, accidental suffocation, infections, trauma etc.

Question 9

What are the RF for SIDS

Answer 9

Maternal

• Young age
• Smoking during pregnancy
• Lack of prenatal care

Other

• Sleeping in the prone position
• Sleeping on a soft surface
• Overheating
• Prematurity
• Smoking in the home
• Low birth weight

Question 10

Why is prone sleeping so bad?

Answer 10

Associated with increased rebreathing of expired gases
Increases the risk of overheating by decreasing rate of heat loss
Alters the autonomic control of the infant’s cardivascular system during sleep and reduce cerebral oxygenation

Question 11

Factors that have led to a reduction in the incidence of SIDS?

Answer 11

Sleeping supine
Avoidance of bumper pads
Avoidance of excess clothing and blankets
Sleeping on a firm surface

Question 12

What is an ATLE/BRUE?

Answer 12

Acute life threatening event

Now termed a BRUE - Brief resolved unexplained event

Question 13

RF for apnea in hospital in patients with RSV

Answer 13

Term babies < 1 month
Preterm babies < 48 weeks after conception (< 2 months corrected)
Those who had a witnessed apneic episode at home