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Management of t h e infant with severe infantile apnea remains controversial. Studies have suggested t h a t home cardiorespiratory monitoring failed t o prevent subsequent deaths from SIDS in a s many a s 10% of patients. In order t o assess the effectiveness of home cardiorespiratory monitoring upon subsequent outcome in severe infantile apnea, 32 infants were evaluated and prospectively followed. These infants represented 8%(32/396) of t h e children seen a t t h e Children's Hospital of Philadelphia during a two year period. All 32 infants had life-threatening apnea requiring cardiopulmonary resuscitation by parents, physicians, or paramedical personnel. Twenty-five (78.1%) were term infants, 7 (21.9%) were preterm babies. Mean + SEM G.A. a t birth was 37.9 + 0.3 wks. Age a t t h e t i m e of initial apneic episode was 8.6 2 1.3 wks. Initial thermistorpneumocardiogram evaluation revealed respiratory pattern abnormalities in 16 (50%) infants: central apnea -5 (15.6%); obstructive apnea -1 (3.2%); periodic breathing -6 (18.7%); gastroesophageal reflux associated apnea -4 (12.5%). All infants were treated with home cardiorespiratory monitoring. Mean + SEM duration of monitoring was 4.7 + 0.5 months.Ten infants (31.3%) had apnea while monitored which required vigorous stimulation. Two infants (6.25%) required vigorous stimulation including CPR. Infants have been followed for a mean of 21.3 + 6.3 SEM months.No deaths have occurred. These results suggest that one-third of infants with severe infantile apnea will have subsequent respiratory episodes a t home. Home monitoring appears t o be a n effective therapy in this group of babies a t highest risk f o r continuing apnea. ~. i x e d apnea of infancy is a respiratory pattern characterized by both central and obstructive apnea. In order t o characterize this form of apnea more completely, 67 patients were evaluated in t h e Apnea Screening Program of The Children's Hospital of Philadelphia. These infants had predominantly mixed apnea and represented 8.1% (671838) of t h e children evaluated f o r apnea during a two year period. Mean BW was 1700 2 88.8 SEM gms, mean GA was 31.6 + 0.4 SEM wks. The average age a t t h e time of study was 5.8 + 0.5 SEM wks. Fifty-nine (88%) infants were premature, eight (12%) were terln babies with infantile apnea or siblings of SIDS victims. Infants were evaluated for a minimum of 6 hours by thermistorpneumocardiogram study. 279 episodes of mixed apnea were detected. 217 (77.8%) episodes began a s central apnea and progressed t o obstructive apnea. 62 episodes (22.2%) initially demonstrated obstructive apnea t h a t subsequently became central. 155 (55.6%) episodes of mixed apnea were accompanied by bradycardia (decrease in heart r a t e >40 bpm below baseline level). The duration of mixed apneic episodes tended t o be prolonged with 85 (30.5%) 10-15 seconds duration, 120 (43%) 15-20 seconds duration, and 74 (26.6%) D 20 seconds duration. Children with predominantly mixed apnea had associated other apnea: 33 (49.3%) had central apnea...