ALTE

Apparent Life-Threatening EventAhmad Althekair, MDFellow, Pediatric Emergency MedicineHospital for sick children

Present factors that place patients at high risk for serious disease or future adverse eventsProvide guidance on taking thorough history of ALTEDescribe guidelines for diagnosis and admission to the hospitalObjective

6 month old boy brought by his mother after he began crying, turned red, and spit up his milk while breastfeeding.Mother feels he stopped breathing for ~ 10 seconds, but after patting his back returned to normalHe is a product of full term, vaginal uncomplicated delivery.His vital signs are normal, playful and appears well in the ED.Case 1

He has had URI symptoms for 2 days with no fever.

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6 week old infant, turned blue while she was sleeping in her mothers arms. Responded after 10 seconds of rubbing the back by her mom.Appears stable by quick assessment with a normal vital signs.Baby was born at 35 weeks gestation and delivered vaginally without complication.Same incident happened 1 week ago while asleep but resolved faster.Case 2

Stayed 2 days in the nursery then discharged.

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Case 3

BackgroundIn 1986, NIH Consensus Development Conference on Infantile Apnea and Home Monitoring defined an apparent life-threatening event (ALTE) as:An episode that is frightening to the observer and that is characterized by some combination ofApnea Color changeChange in muscle toneChocking or gaggingIn some cases, the observer feels that the infant has died.

It has been described in population-based studies as 0.6 to 2.46 per 1000 live births and accounts for 0.6% to 0.8% of all ED visits for children < 1 year .

Unexplained cessation of breathing for more than 20 seconds, or a shorter pause associated with bradycardia, cyanosis, pallor &/or marked hypotonia.6

50% of infants presenting with ALTE will have identified underlying cause after investigation.GERD, seizures, and lower respiratory tract infection.Other less common causes may include CVS disorder, CNS disorder, metabolic disorder, drug toxicity or poisonings, and Non-Accidental Trauma (NAT)

Etiology

Mcgoverns systematic review in Arch Dis Child 2004, 8 studies, 643 infants, all non randomized descriptive studies, 31% GERD, 11%Sz, 8%LRTI, UNKNOWN23%.Other less common causes may include CVS disorder, CNS disorder, metabolic disorder, drug toxicity or poisonings, and Non-Accidental Trauma (NAT)

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ALTESIDSNo gender differenceMale predominanceFull term infantsPretermNormal weight for gestational ageSmall for gestational ageNo maternal age predominanceMaternal age < 20 yearsPeak age < 2 monthsPeak age 2-4 monthsUsually during wakefulnessUsually during sleepUnchanged incidenceDecreased incidence

ALTE and SIDS

2008 study(Esani in J pediatrics), ALTE pts lack male predominance seen in SIDS, ALTE are full birth compared to preterms in SIDS, SIDS pts are small for GA compared to ALTE, maternal age