The evaluation of healthy-appearing infants with a history of apnea is problematic. Occasionally, parents may have misinterpreted acrocyanosis, postprandial regurgitation, or color changes with stooling as an episode of apnea. The parents should be carefully questioned about what they did to revive the baby, for example, stimulation or mouth-to-mouth resuscitation. No resuscitative efforts suggest a benign event. Conversely, the need for mouth-to-mouth resuscitation bespeaks a more serious event. The finding of irregular respiration or poor muscle tone on physical examination would assist in the diagnosis of an ALTE.
Some infants who have experienced an ALTE have not been fully resuscitated in the field. They should receive the benefit of vigorous cardiopulmonary resuscitation, unless signs of irreversible death (livedo reticularis, blood pH of 6, or boxcar venous pooling in the fundi) are apparent. Frequently the heart will resume beating after prolonged arrest. The infant heart is a remarkably resistant organ and may be revived after irreversible brain damage.
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