goodbye alte, hello brue - 15.40-16.00 - dani hall - goodbye...nai as a cause of altes...
TRANSCRIPT
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goodbye ALTE, hello BRUEDani Hall
Consultant in Children’s Emergency Medicine
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George
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Apparent Life Threatening Event
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1%
95%
1%
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ALTE
GIidio-
pathic
resp
neuro
ENTCVS
meta-bolic
Infec-tion
NAI
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ALTE vs SUDI (Sudden unexpected death in infancy)
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NAI as a cause of ALTEs(non-accidental injury)
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So, should we extensively investigate?
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goodbye ALTE hello BRUE
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>60 days
≥32 weeks
Only 1
No CPR
Nil concerning
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SHOULD
- Share decisions
- CPR training
SHOULD NOT
- Do bloods, LPs, CXR, echo, EEG
- Empirically treat reflux
MAY
- Pertussis swab / ECG
- Brief monitoring
NEED NOT
- Viral swabs, urine, glucose, gas
- Admit for observation
Low risk BRUE
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So what should we do with George?
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references1. National Institutes of Health Consensus Development Conference on Infantile Apnea and Home
Monitoring, Sept 29 to Oct 1, 1986. Pediatrics. 1987;79(2):292-299. (Consensus document)
2. Kiechl-Kohlendorfer U, Hof D, Pupp Peglow U, et al. Epidemiology of apparent life threatening events. Arch Dis Child. 2005;90:297-300.
3. Sahewalla R, Gupta D, Kamat D. Apparent Life-Threatening Events: An Overview. Clin Pediatr.2015 doi: 10.1177/0009922815591890
4. Smith MB, Talbot AC. Management of apparent life-threatening events. Paediatr.Child Health. 2009;19(3):114-120.
5. Clinical Practice Guidelines: Apparent Life Threatening Event. Royal Children’s Hospital, Melbourne, Australia.
6. Sarohia M, Platt S. Apparent Life-Threatening Events in Children: Practical Evaluation and Management. Pediatr Emerg Med Prac. 2014;11(4):1-15.
7. McGovern MC, Smith MB. Causes of apparent life threatening events in infants: a systematic review. Arch Dis Child. 2004;89:1043-1048.
8. Tieder JS, Altman RL, Bonkowsky JL, et al. Management of Apparent Life-Threatening Events in Infants: A Systematic Review. J Pediatr. 2013;163(1):94-99
9. Tieder JS, Bronkowsky KL, Etzel RA et al. Brief Resolved Unexplained Events (formerly Apparent Life Threatening Events) and evaluation of lower risk infants. Pediatrics. 2016; 137)5):e20160590