A 3-Week-Old Girl Is Evaluated in the Neonatal Intensive Care

A 3-week-old girl is evaluated in the neonatal intensive care unit due to apnea.  The patient was born at 26 weeks gestation with a birth weight of 820 g (1 lb 13 oz) .  She had mild respiratory distress syndrome initially and has been breathing comfortably on high-flow nasal cannula at 21% FiO₂.  Enteral breast milk feeds have been started.  The patient received ampicillin and gentamicin empirically until cultures were sterile at 48 hours.  On day of life 3, she began having episodes of apnea, with 25-30 seconds without respiratory effort and subsequent bradycardia and desaturations.  These episodes have occurred intermittently for the past several weeks.  The patient recovers spontaneously or with brief stimulation.  In between the episodes, she is well-appearing and has normal vital signs.  The anterior fontanel is slightly sunken and soft.  Lungs are clear to auscultation.  The abdomen is soft and bowel sounds are normal.  Ultrasound of the head on day of life 10 is normal.  Which of the following is the best next step in management of this patient's condition?

A) Chest CT scan
B) No additional testing indicated
C) Repeat ultrasound of the head
D) Sepsis evaluation and antibiotic therapy
E) Video electroencephalogram

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