Most infants resolve apnea of prematurity before discharge and do not require apnea monitoring at home. 15 However, home monitoring is sometimes utilized for premature infants with severe apnea or if apnea persists beyond 38 weeks' postconceptional age.11Z Infants may be brought to an emergency department because of an actual apneic episode or because the parents are not sure of the significance of an alarm. Studies have demonstrated that the majority of alarms at home are not associated with a change in cardiorespiratory status and probably represent monitor dysfunction, such as loose leads. 16 However, caution must be exercised before attributing an alarm to a mechanical problem with the monitor.
All episodes associated with cyanosis or bradycardia, directly observed episodes of apnea, and any episode requiring intervention, such as stimulation or mouth-to-mouth resuscitation, should be thoroughly evaluated and require admission. A recurrence of apnea in a premature infant who was discharged apnea-free warrants admission and a thorough search for the cause. The differential diagnosis ( Table 113-2) includes respiratory infection (especially with RSV or pertussis), sepsis, gastroesophageal reflux and aspiration, aspiration with feedings, anemia, and metabolic problems, such as hypoglycemia. Other, more unusual causes include seizures, cardiac dysrhythmias, and posthemorrhagic hydrocephalus. Therapy is directed toward the specific cause.
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