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)

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.