OBSTRUCTIVE SLEEP-APNEA PRESENTING AS FAILURE-TO-THRIVE IN INFANCY

Objective: To study the postoperative outcome of infants under the age of 18 months in whom an adenotonsillectomy had been performed, with p articular emphasis on the pre- and postoperative weight gain and linea r growth velocities, and the resolution bf symptoms of obstructive sle ep apnoea (OSA). Methodology: A retrospective study of all infants in whom an adenotonsillectomy had been performed during the 5 year period to January 1990. Details of pre- and postoperative outcome variables were obtained by review of hospital and office records and by telephon e calls to the parents. Results: Complete data were available for 29 ( 76%) of the 38 infants in whom an adenotonsillectomy had been performe d. The data from these infants are reported. Pre-operatively, all infa nts had clinical symptoms of OSA, and 52% of infants also presented wi th failure to thrive (FTT). Seven infants were dysmorphic: three had D own syndrome, three had a craniofacial anomaly and one infant had Mobi us syndrome. Following adenotonsillectomy, 23 infants (79%) had comple te resolution of their OSA symptoms. Two infants with Down syndrome re quired a tracheostomy to relieve persistent upper airway obstruction. Eighty-seven per cent of the infants with pre-operative FTT had a sign ificant increase in weight gain velocity postoperatively (mean+/-95.1/-80.8 s.d. vs 509.8+/-249.1 g/month; P<0.001), including the infants with mild persistent symptoms of OSA. The weight gain velocity of infa nts who were not failing to thrive pre-operatively did not change sign ificantly following adenotonsillectomy (328.1+/-106.9 vs 333.2+/-146.4 g/month; P=0.82). The linear growth velocity of all infants did not c hange significantly postoperatively. Conclusions: OSA should be consid ered in infants with FTT, as adenotonsillectomy is an effective treatm ent for OSA in infancy, and the weight gain velocity of these infants may increase significantly postoperatively. Overnight oximetry or othe r physiological studies may be required if the clinical signs and symp toms of OSA are equivocal.