• Julie Hauer and Daniel Mackey.
• Department of General Pediatrics, Children's Hospital Boston, Boston, MA 02115, USA. julie.hauer@childrens.harvard.edu
• J Palliat Med. 2013 Apr 1;16(4):455-8.

BackgroundInfants with neurologic impairment (NI) as a result of injury to the central nervous system have a significant rate of pain. Problems associated with pain in children with NI include increased tone. This secondary hypertonia may contribute to apnea as a result of alterations in airway tone and chest wall movement. Infants are at greatest risk given their smaller airways, lower functional residual capacity, and the high rate of unrecognized pain at this age.DiscussionWe report two cases of infants with NI, identified to have significant improvement in apnea following empiric treatment with gabapentin for presumed central pain and/or visceral hyperalgesia. This correlation between pain and apnea, with resolution in apnea following effective treatment of these presumed sources, has not been previously reported in the literature.ConclusionInfants with NI and apnea should have careful pain assessment and treatment, when considering other causes and interventions for apnea.

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