A neonate with marked prolonged mixed apneas and CHARGE syndrome: a case report

Background

Upper airway abnormalities in the newborn are associated with obstructive breathing but not with mixed apneas. A tracheostomy is necessary to treat severe obstructive apneas but will not have an effect on the central part of the mixed apneas. As far as we know, this is the first case report describing disappearance of severe mixed apneas after tracheostomy in a 7-week-old infant.

Case presentation

We report a case of a white female neonate with anatomical upper airway abnormalities and severe mixed apneas with desaturations needing respiratory support. Polysomnography revealed striking mixed apneas, starting as a prolonged central apnea and merging into an obstructive apnea, and were not appropriate for her age. Additional examination revealed no explanation for the central component of the mixed apneas. Because of persistent, severe desaturations, she needed respiratory support with failure to wean. Finally, a tracheostomy was performed to treat the obstructive apneas, but unexpectedly the central apneas also resolved. Recently, additional genetic testing revealed that she has CHARGE syndrome (coloboma of the eye, heart defects, atresia of the choanae, retardation of growth and development, genital and/or urinary abnormalities, and ear abnormalities and deafness).

Conclusions

Mixed apneas are not a common feature in the newborn or infant with upper airway abnormalities. However, treatment with tracheostomy in our patient (day 46 postpartum) with anatomical upper airway abnormalities resolved not only obstructive apneas but also, unexpectedly, severe mixed apneas. Surprisingly, a posttracheostomy polygraph showed only short central apneas appropriate for age.

Availability and usability of data for medical practice assessment

OBJECTIVE

We analyzed availability and usability of the electronic patient data required for assessment of medical practice for a specific patient group.

DESIGN

Case study in which physicians defined performance indicators and additional exploratory information. Data availability in the hospital information system was determined. Data usability was evaluated based on reason for recording, administrative procedures, and comparison with paper data.

SETTING

A 155 bed pediatric department in a public academic medical center.

STUDY PARTICIPANTS

Pediatricians and children with suspected meningitis.

MAIN OUTCOME MEASURES

Availability and usability of electronic patient data. Usability criteria were standardization, completeness, and accuracy.

RESULTS

A total of 14 performance indicators were defined. Of 39 data items required for indicator quantification, 29 were available, and 19 were usable without manual handling. Completeness and accuracy of the registration of reason for admission and discharge diagnoses were insufficient, leading to problematic patient selection and complication detection. Time-points of patient events were inaccurate or not available. Data regarding outpatient diagnosis, signs and symptoms, indications for test ordering, and medication administration were missing. Test result reports were not adequately standardized. Based on electronic patient data, five out of 14 performance indicators could be quantified reliably, but only after patient selection problems were overcome. For exploratory information, 16 out of 25 required data items were available and 13 were usable.

CONCLUSIONS

Availability and usability of electronic patient data are insufficient for physician-led and detailed assessment of medical practice for specific patient groups. Extended registration of the reason for admission will improve patient selection and assessment of diagnostic process.

Availability and accuracy of electronic patient data for medical practice assessment

We analyzed availability and accuracy of electronic patient data needed to assess medical practice. A case study was performed in which pediatricians formulated 14 performance indicators that cover aspects of care for children with suspected meningitis. Data items needed to quantify these indicators were listed. Required patient data were gathered from hospital information system and paper medical records. Accuracy of electronically available data was based on comparison with paper data and, when paper data were not available, on how data were recorded at the source, administrative procedures and original goal for which data were recorded.

CONCLUSION

Registration of reason for admission and diagnoses gives no reliable basis to select patients with 'suspicion on a disease' as selection criterion. Besides, many performance indicators cannot be reliably quantified because data are not recorded electronically (indication, medication, outpatient diagnosis), are not recorded specific enough (intervention time), are not standardized (radiology report), or cannot be obtained from other hospitals.