FAILURE-TO-THRIVE AND OBSTRUCTIVE SLEEP-A PNEA IN INFANTS

Background. Obstructive sleep apnea ran induce growth retardation, wit h cardiac and/or neurologic manifestations. Tonsillectomy and adenoide ctomy may improve failure to thrive. Case reports. Case n-degrees 1 : A 11 1/2-month-old boy was admitted because of feeding problems plus c hronic nasopharyngeal secretions eventually purulent) since the first months of life. He showed a low rate of weight gain since the age of 7 months and had been treated treated for gastroesophageal reflux for a few weeks. On admission, his weight was 6,220 g and his height was 70 .5 cm. The tonsils were enlarged and the uvula was long. He displayed tachycardia (150/min). Polygraphic recordings during sleep showed nume rous episodes of obstructive apnea. Arterial oxygen saturation (SaO2) during the night was low, frequently below 80 %. Tonsillectomy and ade noidectomy immediately improved the quality of sleep. Nocturnal SaO2 a nd cardiac rythm improved one week later; there was a catch-up weight one month after surgery. Case n-degrees 2: A 7-month-old boy, was admi tted because chronic manifestations similar to those of case no 1. His weight was 5,900 g and his height was 67.5 cm. He also had enlarged t onsils. He suffered from episodes of snoring and obstructive sleep apn ea followed by waking and sweating. PaO2 was 70 mmHg and PaCO2 was 48 mmHg. Nocturnal SaO2 was frequently below 60 %. Tonsillectomy and aden oidectomy resulted in a net improvement in sleep and weight, despite p ersistent episodes of noctumal hypoxemia. Conclusions. Chronic hypertr ophic tonsils and adenoids can interfere with weight gain. Growth reta rdation may dramatically improve after surgery, even if the tonsils an d adenoids do not completely obstruct the nasopharynx.