Evaluation of healthy full-term and late preterm infants
presenting with apnea in the newborn nursery: A comparison of neonatal apnea
and infantile acute life threatening event (ALTE)
Affiliations: Ospedale San Gerardo di Monza, Istituto Maria Letizia
Verga, Monza, Italy | Pediatric Pulmonary and Newborn Medicine, Boston
Children's Hospital, Boston, MA, USA
Note: [] Corresponding author: Lawrence M. Rhein, MD, Enders 480, Boston
Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA. Tel.: +1 (617)
355 3185; Fax: +1 (617) 730 0240; E-mail: Lawrence.Rhein@childrens.harvard.edu
Abstract: Objective: To describe common etiologies and diagnostic evaluations
performed on term and late preterm neonates with neonatal apnea and to compare
these etiologies and evaluations with those infants with infantile acute life
threatening event (ALTE). Methods: Infants %isn't in document <
3 months of age and gestational age > 35 weeks, with diagnosis of apnea or
ALTE were identified at Boston Children's Hospital from June 2000 to June 2009.
Medical records were reviewed for diagnostic evaluations and discharge
diagnoses. For analysis, neonates who presented with neonatal apnea within the
first week of life and prior to discharge from the birth hospitalization were
classified as the Inpatient Group and infants who presented with apnea post
discharge were identified as the Outpatient Group. Infants with clear
presenting etiologies were excluded from the study. Results: One hundred
otherwise healthy subjects with diagnosis of apnea or ALTE in the study period
were identified. Approximately one third were classified as the Inpatient
Group. Diagnostic evaluations were highly variable, but testing for bacterial
or viral sepsis was most commonly performed. In most cases, an etiology was not
determined, and the diagnosis of "apnea of immaturity" was assigned. Other
defined etiologic diagnoses included viral infection or pertussis,
reflux/aspiration, laryngomalacia, and seizures. Conclusions: Diagnostic evaluation for apnea, in otherwise well-appearing full-term and late
preterm infants, remains highly variable. Testing for infection, seizure,
laryngomalacia and reflux may determine the majority of treatable etiologies.
Guidelines for diagnostic evaluations and treatment strategies are clearly needed.
Keywords: Apnea, acute life threatening event, ALTE
