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Question 1 • Paediatrics
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A 4-month-old male infant is brought to the Emergency Department by his anxious parents. They report that they were trying to settle him in his crib, and he was crying, when suddenly he became unresponsive. This happened approximately 20 minutes ago. The infant appeared to have stopped breathing for about 30 seconds, during which time his skin colour changed to "bluish-grey." The episode resolved spontaneously before their arrival, and the infant now appears well.


The father mentions that he has a history of epilepsy since childhood and is concerned that this might be happening to his son. He states that no shaking or rhythmic movements were observed during the episode. This is the first such episode, and the infant was born at term with no complications during delivery.


On examination, the infant has the following observations:

Heart rate: 138 beats per minute

Respiratory rate: 40 breaths per minute

Blood pressure: 88/56 mmHg

Temperature: 36.8°C

Oxygen saturation: 98% on room air

Alert and smiling


Clinical examination reveals a well-appearing infant who is alert and interactive. Cardiorespiratory examination is normal with no murmurs or adventitious sounds. Neurological examination shows normal tone, reflexes, and no focal deficits. Fontanelle is soft and flat.


Past medical history is unremarkable. The infant is exclusively breastfed and has been gaining weight appropriately. Immunisations are up to date. There is a family history of epilepsy (father) and asthma (maternal grandmother).


What is the most appropriate next step in management?

A

Admission for 24-hour cardiorespiratory monitoring

B

Urgent EEG and neuroimaging

C

Reassurance and discharge with safety-net advice

D

Commencement of phenobarbital prophylaxis

E

Full septic screen including lumbar puncture

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