Navya Rallapalli

Definition :

Pathologic apnea is a cessation of respiratory effort or

airflow for 20s or of shorter duration when
accompanied by bradycardia or hypoxemia.
Types
Central:
Absence of airflow due to lack of ventilatory effect
Obstructive
Absence of airflow despite ventilatory effect.
Mixed
Initial central component followed by an obstructive
component
 AOP reflects more of physiologic process rather than a
pathologic entity.

In contrast apnea in term babies is mostly pathologic.

Apnea from birth to three days.

Apnea in later infancy, from more than three days to

one year.
Apnea from birth to three days.
Birth : Hypoxic or Ischemic brain injury
Intrapartum maternal Drug/GA
Early Onset sepsis.
Central : Congenital CNS malformations,
Seizures ischemic infarction/stroke,
Temporal lobe lesions,
Metabolic causes
Intracranial hemorrhage,
Inflammation secondary to pneumonia,
sepsis, or meningitis.
 Positional :
SUPC:
Feeding related hypoventilation/Apnoea
Obstructive :

Functional causes Syndromes of

laryngomalacia,
vocal cord paralysis or
paresis, phrenic nerve injury,
stimulation of the laryngeal
chemo reflex from reflux
problems with coordination
of sucking, swallowing, and
breathing
oropharyngeal airway
obstruction
Pierre Robin sequence,
Treacher Collins syndrome,
Goldenhar syndrome,
Crouzon disease,
Down syndrome.

Congenital Central Hypoventilation Syndrome.

CCHS / Ondines curse
CCHS affects the CNS and ANS
Mutation in the PHOX2B gene.
PRAM and NPRAM mutations.
Reduced or shallow breathing, mostly in sleep.
Cardiac asystoles ,hypothermia , BP variations
Hirschsprungs disease- NPARMs
Eye:Strabismus, abnormal pupil dilation, absent or reduced
depth perception.
Growth hormone deficiency and congenital
hyperinsulinemia.
Tumors of neural crest origin.
 Apnea from >3 days to one year

Periodic Breathing is characterized by cycles in which a

few breaths of 5-10 s alternate with periods of apnea of a
similar duration.
PB, absent in the first few days of life, becomes frequent
at 2-4 weeks of age, and is rare by six months
 Kelly et al..
CHIME Study
Brockmann et al.
A single center reviewed infants diagnosed with
obstructive sleep apnea (OSA) by polysomnography.
Causes of OSA in infancy were different than those
found in older children.
Gastroesophageal reflux (GER) 30%
laryngomalacia in 24%
and craniofacial anomalies in 16%
Genetic conditions were identified in 53%, most
frequently trisomy 21
 ALTE
A BRUE is an event
occurring in infants <1 year
of age with one or more of
the following:
cyanosis or pallor
absent,decreased,or
irregular breathing
marked change in tone
(hyper/hypotonia)
altered level of
responsiveness
BRUE
Low risk infants are
defined by:
> 60 days of age
gestational age >32 weeks
and >45 weeks of
postconceptional age;
event duration <1 min
no CPR
no significant historical
features
no concerning physical
findings
High risk infants
Retrospective review of infants
with ALTE
10
12 30

35 20
 GER

RSV :
Causes ANS dysfuntion
Depends to previous Respiratory condition

Suspected Petrussis

Inborn errors of metabolism causing acute metabolic

encepalopathy.
Evaluation
Maternal, prenatal, intrapartum, resuscitation, and
postpartum history.
Feeding history
General and Systemic examination
Lab: Biochemistry and FBC.
Neuroimaging
EEG
ENT consultation
Genetics
SALT assessment
Management and Prevention
Strategies
ABC
CPAP
Management : Underlying Causes
?Caffiene

Encourage safe SSC

Safe sleep Practices