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The diagnosis of a breath-holding spell is made clinically. A good history including the sequence of events, lack of incontinence and no postictal phase, help to make an accurate diagnosis. Some families are advised to make a video recording of the events to aid diagnosis. An electrocardiogram (ECG) may rule out cardiac arrhythmia as a cause. [1]
[1] [5] Approximately 85 percent of infants born with a weight less than 2.2 pounds (1 kg) experience infantile apnea within the first month after birth. [4] This risk decreases to 25 percent for infants weighing less than 5.5 pounds (2.5 kg). [4] Studies have found that almost 2% of the pediatric population experience obstructive sleep apnea. [1]
Over 50% of infants who are born preterm are estimated to be affected by apnea of prematurity. [2] Infants who are born weighing less than 1000g have close to a 100% risk of being affected by apnea of prematurity. Most premature infants are affected by 'central' apnea due to the developmental stage of their respiratory tract. [2]
Apnea (also spelled apnoea in British English) [1] is the temporary cessation of breathing.During apnea, there is no movement of the muscles of inhalation, [citation needed] and the volume of the lungs initially remains unchanged.
When affected babies cry or have a bowel movement, they may undergo a "tet spell" where they turn cyanotic, have difficulty breathing, become limp, and occasionally lose consciousness. [2] Other symptoms may include a heart murmur, finger clubbing, and easy tiring upon breastfeeding. [2] The cause of tetralogy of Fallot is typically not known. [5]
Transient tachypnea of the newborn occurs in approximately 1 in 100 preterm infants and 3.6–5.7 per 1000 term infants. It is most common in infants born by caesarian section without a trial of labor after 35 weeks of gestation. Male infants and infants with an umbilical cord prolapse or perinatal asphyxia are at higher risk.
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Also, for infants in the high-risk category, clinicians should consider admission to the hospital for extended observation, depending on the benefits and risk of the case. [4] The course of the admission provides an opportunity to witness a second event to better characterize it and narrow the list of possible diagnoses.