Advertisement

European Journal of Pediatrics

, Volume 163, Issue 2, pp 108–115 | Cite as

Recommended clinical evaluation of infants with an apparent life-threatening event. Consensus document of the European Society for the Study and Prevention of Infant Death, 2003

  • André KahnEmail author
Original Paper

Abstract

Infants with an apparent life-threatening event (ALTE) should not be treated nor monitored without a detailed medical evaluation, as different medical causes may be responsible for the initial clinical presentation. Standard and specific evaluation procedures are listed to help identify a cause for the ALTE. The most frequent problems associated with an ALTE are digestive (about 50%), neurological (30%), respiratory (20%), cardiovascular (5%), metabolic and endocrine (under 5%), or diverse other problems, including child abuse. Up to 50% of ALTEs remain unexplained. The finding of medical or surgical anomalies leads to specific treatments. Surveillance programmes with the use of home monitoring devices may be undertaken, preferably with cardiorespiratory monitors, and when possible, with event monitors, although no currently available home monitoring device is free of false alarms or offers complete protection. Long-term follow-up programmes of infants with an apparent life-threatening event contribute to adapt medical attitudes to the child’s needs and to confirm the medical diagnosis. Conclusion: a systematic diagnostic evaluation, together with a comprehensive treatment programme, increases survival and quality of life for most affected infants.

Keywords

Apnoea Apparent life-threatening event Death Sleep Sudden infant death 

Abbreviations

ALTE

apparent life-threatening event

SIDS

sudden infant death syndrome

References

  1. 1.
    Al-Kindy H, Côté A (2003) Extreme cardiorespiratory events in infants hospitalized for ALTE. Am J Resp Crit Care Med. 167: A677Google Scholar
  2. 2.
    American Academy of Pediatrics (2003) Apnea, sudden infant death syndrome, and home monitoring. Pediatrics 111: 914–917PubMedGoogle Scholar
  3. 3.
    American Thoracic Society (1996) Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med 153: 866–878PubMedGoogle Scholar
  4. 4.
    Arad-Cohen N, Cohen A, Tirosh E (2000) The relationship between gastroesophageal reflux and apnea in infants. J Pediatr 137: 321–326CrossRefPubMedGoogle Scholar
  5. 5.
    Arens R, Gozal D, Jain K (1993) Prevalence of medium-chain acyl-CoA dehydrogenase deficiency in the sudden infant death syndrome. J Pediatr 122: 715–718PubMedGoogle Scholar
  6. 6.
    Arens R, Gozal D, Williams JC, Davidson-Ward SL, Keens TG (1993) Recurrent apparent life threatening events during infancy: a manifestation of inborn errors of metabolism. J Pediatr 123: 415–418PubMedGoogle Scholar
  7. 7.
    Ariagno RL, Guilleminault C, Baldwin R (1982) Movements and gastroesophageal reflux in awake term infants with “near-miss” SIDS, unrelated to apnea. J Pediatr 100: 894–897PubMedGoogle Scholar
  8. 8.
    Becroft DMO, Thompson JMD, Mitchell EA (2001) Nasal and intrapulmonary haemorrhages in sudden infant death syndrome. Arch Dis Child 85: 116–120CrossRefPubMedGoogle Scholar
  9. 9.
    Bergman AB, Ray CG, Pomeroy MA, Wahl PW, Beckwith JB (1972) Studies of the sudden infant death syndrome in King County.Washington III. Epidemiology. Pediatrics 49: 860–870PubMedGoogle Scholar
  10. 10.
    Caffey J (1974) The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked with whiplash-induced intracranial and intraocular bleedings, linked with residual permanent brain damage and mental retardation. Pediatrics 54: 396–403PubMedGoogle Scholar
  11. 11.
    Corwin MJ, Lister G, Silvestri JM, Peucker M, Brooks LJ, Ward SLD, Hunt CE, Neuman MR, Crowell DH, Colton T and The CHIME Study Group (1998) Agreement among raters in assessment of physiologic waveforms recorded by a cardiorespiratory monitor for home use. Pediatr Res 44: 682–690PubMedGoogle Scholar
  12. 12.
    Côté A, Hum C, Brouillette RT, Themens M (1998) Frequency and timing of recurrent events in infants using home cardiorespiratory monitors. J Pediatr 312: 783–789Google Scholar
  13. 13.
    Dancea A, Côté A. Rohlicel C, Bernard C, Oligny LL (2002) Cardiac pathology in sudden unexpected infant death. J Pediatr 141: 336–342CrossRefPubMedGoogle Scholar
  14. 14.
    Daniëls H, Naulaers G, Deroost F, Devlieger H (1999) Polysomnography and home documented monitoring of cardiorespiratory pattern. Arch Dis Child 81: 434–436PubMedGoogle Scholar
  15. 15.
    Davidson Ward SL, Keens TG, Chan LS, Chipps BE, Carson SH, Deming DD, Krishna V, MacDonald HM, Martin GI, Meredith KS, Merritt TA, Nickerson BG, Stoddard RA, van der Hal AL(1986) Sudden infant death syndrome in infants evaluated by apnea programs in California. Pediatrics 77: 451–455PubMedGoogle Scholar
  16. 16.
    Davis JM, Metrakos K, Aranda JV (1986) Apnoea and seizures. Arch Dis Child 61: 791–806PubMedGoogle Scholar
  17. 17.
    DeMaio JG, Harris MC, Deuber C, Spitzer AR (1989) Effect of blood transfusion on apnea frequency in growing premature infants. J Pediatr 114: 1039–1041PubMedGoogle Scholar
  18. 18.
    Desmarez C, Blum D, Montauk L, Kahn A (1987) Impact of home monitoring for sudden infant death syndrome on family life. A controlled study. Eur J Pediatr 146: 159–161PubMedGoogle Scholar
  19. 19.
    Edner A, Katz-Salamon M, Lagercrantz H, Ericson M, Milerad J (2000) Heart rate variability in infants with apparent life-threatening events. Acta Paediatr 89: 1326–1329CrossRefPubMedGoogle Scholar
  20. 20.
    Edner A, Wennborg M, Alm B, Lagercrantz H (2003) To be or not to be after alte. ESPID Oslo CongressGoogle Scholar
  21. 21.
    Farrell PA, Weiner GM, Lemons JA (2002) SIDS, ALTE, apnea, and the use of home monitors. Pediatr Rev 23: 3–9PubMedGoogle Scholar
  22. 22.
    Guilleminault C, Pelayo R, Leger D, Philip P (2000) Apparent life-threatening events, facial dysmorphia and sleep-disordered breathing. Eur J Pediatr 159: 444–449CrossRefPubMedGoogle Scholar
  23. 23.
    Guntheroth WG (1995) Crib Death. The sudden infant death syndrome, 3rd edn. Futura Publishing Co, Armonk, NY pp 164–166Google Scholar
  24. 24.
    Hall DE, Eubanks L, Meyyazhagan S, Kenney RD, Cochran Johnson S (2000) Evaluation of covert video surveillance in the diagnosis of Munchausen syndrome by proxy: lessons from 41 cases. Pediatrics 150: 1305–1312Google Scholar
  25. 25.
    Hasselmeyer EG, Hunter JC (1985) Sudden infant death syndrome. Child Health 4: 120–141Google Scholar
  26. 26.
    Hewertson J, Poets CF, Samuels MP, Boyd SG, Neville BG, Southall DF (1994) Epileptic seizures-induced hypoxemia in infants with apparent life-threatening events. Pediatrics 94: 148–156PubMedGoogle Scholar
  27. 27.
    Hoppenbrouwers T, Hodgman JE, Arakawa K, McGinty DJ, Mason J, Harper RM, Sterman MB (1978) Sleep apnea a part of a sequence of events: a comparison of three months old infants at low and increased risk of sudden infant death syndrome (SIDS). Neuropädiatrie 9: 320–337Google Scholar
  28. 28.
    Hunt CE, Brouillette RT (1987) Sudden infant death syndrome: 1987 perspective. J Pediatr 110: 669–678PubMedGoogle Scholar
  29. 29.
    Kahn A, Blum D, Hennart P, Sellens C, Samson-Dollfus D, Tayot J, Gilly R, Dutruge J, Flores R, Sternberg B (1984) A critical comparison of the history of sudden-death infants and infants hospitalised for near-miss for SIDS. Eur J Pediatr 143: 103–107PubMedGoogle Scholar
  30. 30.
    Kahn A, Sottiaux M, Appelboom-Fondu J, Blum D, Rebuffat E, Levitt J (1989) Long-term development of children monitored as infants for an apparent life-threatening event during sleep: a 10-year follow-up study. Pediatrics 83: 668–673PubMedGoogle Scholar
  31. 31.
    Kahn A, Rebuffat E, Sottiaux M, Dufour D, Cadranel S, Reitener R (1991) Arousals induced by proximal esophageal reflux in infants. Sleep 14: 39–42PubMedGoogle Scholar
  32. 32.
    Kahn A, Rebuffat E, Franco P, N’Duwimana M, Blum D (1992) Apparent life-threatening events and apnea of infancy. In: Berckerman RC, Brouillette RT, Hunt CE (eds)Respiratory control disorders in infants and children. Williams and Wilkins, New York pp 178–189Google Scholar
  33. 33.
    Kahn A, Bauche P, Groswasser J, Dramaix M, Scaillet S and the workding group of the Groupe Belge de Pédiatres Francophones (2001) Maternal education and risk factors for sudden death in infants. Eur J Pediatr 160: 505–508CrossRefPubMedGoogle Scholar
  34. 34.
    Krongrad E, O’Neill L (1986) Near miss sudden infant death syndrome episodes ? A clinical and electrocardiographic correlation. Pediatrics 77: 811–815PubMedGoogle Scholar
  35. 35.
    McNamara F, Sullivan CE (2000) Obstructive sleep apnea in infants: relation to family history of sudden infant death syndrome, apparent life-threatening events, and obstructive sleep apnea. J Pediatr 136: 318–323CrossRefPubMedGoogle Scholar
  36. 36.
    Meny RG, Carrol JL, Carbone MT, Kelly DT (1994) Cardiorespiratory recordings from infants dying suddenly and unexpectedly at home. Pediatrics 93: 44–49PubMedGoogle Scholar
  37. 37.
    Milerad J (1987) Effects of theophylline on ventilatory response to hypoxic challenge. Arch Dis Child 62: 1242–1246PubMedGoogle Scholar
  38. 38.
    Mitchell EA, Thompson JMD (2001) Parental reported apnoea, admissions to hospital and sudden infant death syndrome. Acta Paediatr 90: 417–422CrossRefPubMedGoogle Scholar
  39. 39.
    Moon RY, Patel KM, McDermott-Shaefer SJ (2000) Sudden infant death syndrome in child care settings. Pediatrics 106: 295–300PubMedGoogle Scholar
  40. 40.
    Moon RY, Weese-Mayer DE, Silverstri JM (2003) Nighttime child care: inadequate sudden infant death syndrome risk factor knowledge, practice, and policies. Pediatrics 111: 795–799PubMedGoogle Scholar
  41. 41.
    National Institutes of Health (1987) Consensus development conference on infantile apnea and home monitoring, Sept 29 to Oct 1, 1986. Pediatrics 79: 292–299PubMedGoogle Scholar
  42. 42.
    Oren J, Kelly D, Shannon DC (1986) Identification of a high-risk group for sudden infant death syndrome among infants who were resuscitated for sleep apnea. Pediatrics 77: 495–499PubMedGoogle Scholar
  43. 43.
    Poets CF, Meny RG, Chobanian MR, Bonofiglo RE (1999) Gasping and other cardiorespiratory patterns during sudden infant deaths. Pediatr Res 45: 350–354PubMedGoogle Scholar
  44. 44.
    Ramanathan R, Corwin MJ, Hunt CE, Lister G, Tinsley L, Baird T, Silvestri JM, Crowell DH, Hufford D, Martin RJ, Neuman M, Weese-Mayer DE, Cupples LA, Peucker M, Willinger M, Keens TG, and The Collaborative Home Infant Monitoring Evaluation (CHIME) Study Group (2001) Cardiorespiratory events recorded on home monitors: comparison of healthy infants with those at increased risk for SIDS. JAMA 285: 2199–2207CrossRefPubMedGoogle Scholar
  45. 45.
    Ruggins NR, Milner AD (1993) Site of upper airway obstruction in infants following an acute life-threatening event. Pediatrics 91: 595–601PubMedGoogle Scholar
  46. 46.
    Samuels MP, Southall DP (2003) Alarms during apparent life-threatening events. Am J Respir Crit Care Med 167: A677Google Scholar
  47. 47.
    Spitzer AR, Fox WW (1986) Infant apnea. Pediatr Clin North Am 33: 561–567PubMedGoogle Scholar
  48. 48.
    Tirosh E, Colin AA, Tal Y, Zolikovsky Z, Jaffe M (1990) Practical approach to the diagnosis and treatment of apnea of infancy. Isr J Med Sci 26: 429–433PubMedGoogle Scholar
  49. 49.
    Trowitzsch EW, Meyer G, Schluter B, Buschatz D, Andler W (1992) A life-threatening event in infants: results of polysomnography and examination of a group of 122 infants. Monatschr Kinderheilkd 140: 233–236Google Scholar
  50. 50.
    Valdes-Dapena (1980) Sudden infant death syndrome: a review of the medical literature 1974–1979. Pediatrics 66: 597–614PubMedGoogle Scholar
  51. 51.
    Vandenplas Y, De Wolff D, Sacre L (1986) Influence of xanthines on gastroesophageal reflux in infants at risk for sudden infant death syndrome. Pediatrics 77: 807–810PubMedGoogle Scholar
  52. 52.
    Weese-Mayer DE, Brouillette RT, Morrow AS, Conway L, Klemka-Walden LM, Hunt CE (1989) Assessing validity of infant monitor alarms with event recording. J Pediatr 115: 702–708PubMedGoogle Scholar
  53. 53.
    Weese-Mayer DE, Morrow AS, Conway LP, Brouillette RT, Silvestri JM (1990) Assessing clinical significance of apnea exceeding fifteen seconds with event recording. J Pediatr 117: 568–574PubMedGoogle Scholar
  54. 54.
    Wennergren G, Milerad J, Lagercrantz H, Karlberg P, Svenningsen NW, Sedin G, Andersson D, Grogaard J, Bjure J (1987) The epidemiology of attacks of lifelessness and SIDS in Sweden. Acta Paediatr Scand 76: 898–906PubMedGoogle Scholar
  55. 55.
    Wilson AC, Moore DJ, Moore MH, Martin AJ, Staugas REM, Kennedy JD (2000) Late presentation of upper airway obstruction in Pierre Robin sequence. Arch Dis Child 83: 435–438CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  1. 1.University Hospital for ChildrenBrussels Belgium

Personalised recommendations