Infant home apnea monitoring. A five-year assessment.

Home apnea/bradycardia monitoring is commonly utilized in the management of infants who have had apnea episodes. Little is established, however, regarding appropriate decision-making guidelines and efficacy. The 5-year experience of the Western Massachusetts Apnea Evaluation Program was reviewed to examine patient outcome and to identify prognostic clinical features. Significant recurrent sleep apnea occurred in 7 of 110 infants in the combined awake and asleep group, and in 2 of 45 siblings of babies dying of SIDS. Unclear histories, normal laboratory tests, and uncertain diagnoses made it impossible to identify features that would indicate infants at risk for recurrence of apnea. Our data indicate that home apnea monitoring lacks specificity but is probably effective in reducing morbidity and mortality. It currently appears to be the most optimal means of managing infantile apnea.

The jittery newborn and infant: a review.

Jitteriness is an involuntary movement that is particularly frequent in the newborn. Its hallmark is tremor. The pathogenesis is poorly understood. Jitteriness is often accompanied by other signs of central nervous system excitation, such as hypermotility, hypertonicity, and ease of startle. It must be differentiated from myoclonus and seizure, although they may coexist. Jitteriness can be caused by a variety of pre-, peri-, and postnatal insults, and it is the nature and treatability of these, rather than the tremor itself, that are the major determinants of the ultimate prognosis. "Coarse" tremor is probably more often abnormal than "fine" tremor, and appears to bear some relationship to the later development of a choreiform syndrome. The evaluation of the jittery infant must be individualized and management aimed at reversing any remediable causes.

Apnea documentation for determination of brain death in children.

Discontinuing ventilatory support for determination of respiratory drive is a recognized means of assessing clinical brain death. Methodology must include a means for assuring adequate oxygenation during the test as well as providing sufficient duration for appropriate hypercarbia. Nine patients with other findings of clinical brain death were prospectively assessed with a standardized apnea test protocol. None demonstrated spontaneous respirations. Whereas adequate oxygenation was maintained in each case, wide variability was evident in degree of hypercarbia and acidosis.

Brain death in the pediatric intensive care unit. A clinical definition.

The establishment of criteria for brain death is important for decision making in the treatment of critically ill patients. Our experience involving 15 children with coma, apnea, and absent brain-stem reflexes for a period of greater than three days supports previous reports in adults that the diagnosis of brain death can be made by clinical criteria alone. None of these patients survived, and each of the 11 autopsies performed revealed marked liquefactive necrosis in the brain.