Apnea Spells in a Term Neonate.

1. Tara E. Ness, MD, MPH* 2. Brian C. King, MD* 3. Marcia Kukreja, MD* 4. Nathan C. Sundgren, MD, PhD* 1. *Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX A boy was born at 39 weeks and 4 days of gestation to a 32-year-old gravida 2, para 2 mother via spontaneous vaginal delivery with meconium fluid. Apgar scores were 6 (0 for muscle tone and 0 for skin color) and 9 (1 for skin color) at 1 and 5 minutes, respectively, and he received routine resuscitation in the form of warming, drying, and stimulating. He was admitted to the mother-baby unit for routine newborn care and initiated on ampicillin and gentamicin (after routine blood samples were collected) for maternal chorioamnionitis (elevated maternal heart rate and elevated white blood cell count to 10,460/μL [10.46 × 109/L]). He was noted to have left arm weakness secondary to a presumed shoulder dystocia. Five hours after birth the infant was observed to have 2 apneic events with central cyanosis requiring blow-by oxygen. Vital signs were otherwise normal, and a point-of-care glucose level was normal. The spells lasted approximately 1 to 2 minutes and required moderate stimulation. The infant returned to baseline after the events and had been feeding and voiding normally. It was decided that the infant should be transferred to the NICU for further observation and evaluation. During transport to the unit the patient had another apneic event accompanied by oxygen desaturation to 55% to 60%. All the spells occurred when at rest and were not associated with feeding or changes in heart rate. Between these events, the infant had normal oxygen saturation, and during each event the infant was stimulated and was observed to spontaneously begin breathing again. After arrival at the NICU, head ultrasonography and chest radiography were obtained, the results of both of which …