Assessment of neurologic status in the newborn infant is nonspecific
with limited specificity and sensitivity. However, certain signs of
neurologic dysfunction require immediate evaluation. Apnea is common,
especially in preterm infants. Sustained apnea must be distinguished
from periodic breathing. Sustained or pathologic apnea is accompanied
by changes in color and perfusion. Any suspicious apnea must be
evaluated with pulse oximetry and blood gas analysis. Apnea may
be a reflection of systemic disease, heralding sepsis, meningitis,
or pulmonary pathology. Apnea may also indicate a primary neurologic
problem. Neonatal seizures may present as apnea. Hypoxic-ischemic
insults or intracranial hemorrhage may result in apnea at delivery.
Maternal medications such as narcotics or barbiturates may cross
the placenta and blunt respiratory drive. Therapeutic intervention
is based on supporting appropriate ventilation and oxygenation. In
some instances, tactile stimulation is sufficient to address apneic
events. However, persistent apnea should be treated with positive pressure
ventilation (not necessarily with tracheal intubation) to maintain
normal acid-base balance and normocarbia and to prevent hypoxia
until the cause can be determined or eradicated. Diagnostic evaluation
should be developed on the basis of presenting signs and symptoms
and may include imaging studies of the brain, diagnostic studies
of cerebral spinal fluid, blood gas analysis, and evaluation for
infection.