Initial laboratory evaluation of infants with 'presumed near-miss' sudden infant death syndrome
J. M. Lewis and D. J. Ganick
We reviewed the cases of 201 infants hospitalized for "presumed near-miss"
sudden infant death syndrome over a recent five-year period to determine
the value of routine initial laboratory investigations in establishing
diagnosis or altering therapy. A total of 1,278 measurements were performed
on 163 patients aged 3 days to 6 months; 276 (22%) of the results were
outside the normal limits for age. The most common abnormalities were
hyperchloremia (58% of infants tested), hypermagnesemia (43%),
hypobicarbonatemia (33%), and hyperkalemia (27%). There were no instances
of polycythemia, hypochloremia, hypokalemia, hyperbicarbonatemia, or
uremia. Only six (0.5%) of the abnormal values in four patients were useful
in diagnosing or treating the apneic episodes. Infants with respiratory
symptoms at the time of presentation had a statistically greater incidence
of abnormal values than patients who were asymptomatic. Because of the low
yield of useful information, we conclude that the use of a routine battery
of laboratory investigations in the initial evaluation of infants with
presumed near-miss sudden infant death syndrome should be questioned.
