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B. Gastroesophageal Reflux Disease (GERD) or Dysphagia. GERD can be associated with obstructive apnea, esophagitis, bron-chospasms, and growth failure. Stimulation of chemoreceptors in the upper airway and lower esophagus can lead to obstructive apnea.

Seizure or Other Neurologic Abnormality. Usually associated with behavioral changes and daytime symptoms. Sepsis or Infection (Bacterial, Viral). Respiratory syncytial virus (RSV), pertussis, and serious underlying infections can often present with central apnea.

Cardiac Disease. History and physical exam usually provide clues to these disorders.

Anemia. Consider, particularly in a young infant with a history of prematurity.

Breath-holding Spell. Associated with emotional outbursts or stressful situations.

Upper Airway Obstruction (eg, laryngomalacia). See Chapter 84, Stridor, p. 393.

Metabolic Disorder. Inborn errors of metabolism can present as ALTE in young infants. Metabolic disorders often present with metabolic acidosis.

Traumatic Child Abuse. See Chapter 14, Child Abuse: Physical, p. 70.

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