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Independent risk factors for recurrence of apparent life-threatening events in infants

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Abstract

The risk factors for recurrent apparent life-threatening event (ALTE) are unclear although the risk of recurrent ALTE is an important consideration for the management of ALTE patients. This study aimed to identify the risk factors for recurrent ALTE. We conducted a secondary analysis of the data from a single center retrospective cohort study in Japan conducted from March 2002 to January 2012, which included children diagnosed with ALTE at a pediatric emergency department (ED) in Tokyo. Among 112 ALTE patients, 18 (16%) had recurrences and 94 (84%) did not. Symptoms of respiratory tract infection (RTI) were more frequent in the recurrent group than in the non-recurrent group (44 vs. 14% p = 0.0055), and the proportion of patients triaged as level 1 was larger in the recurrent group than in the non-recurrent group (31 vs. 7%, p = 0.0312). Pallor was observed more frequently in the recurrent group than in the non-recurrent group (100 vs. 76%, p = 0.0216). Multivariate analysis demonstrated that the independent risk factors of recurrent ALTE were respiratory tract infection symptoms (OR, 5.02; 95% CI, 1.48–16.98).

Conclusion: ALTE patients who had RTI symptoms at the ED visit for first ALTE should be admitted for close observation of potential recurrences.

What is Known:

• Approximately 10% of ALTE patients experienced recurrence of ALTE episodes.

• The risk of recurrent ALTE is one of the major consideration for the management of ALTE patients at the ED because these patients have higher rates of serious underlying diseases which require interventions.

What is New:

• Respiratory infection symptoms at ED presentation can be independent risk factors for recurrent ALTE.

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Abbreviations

ALTE:

Apparent life-threatening event

BRUE:

Brief resolved unexplained event

ED:

Emergency department

PICU:

Pediatric intensive care unit

RTI:

Respiratory tract infection

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Acknowledgements

We would like to thank Dr. Julian Tang of the Department of Education for Clinical Research, National Center for Child Health and Development, for proofreading and editing this manuscript.

Authors’ contributions

RU: All facets of the study from study design to data collection and analysis and finally, completion of the manuscript. ON: Study concept development, design, data interpretation, and manuscript review. TM: data analysis and manuscript revision. HS and SN: Interpretation of the data and manuscript review. AI: Interpretation of the data and manuscript revision and editing. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan

    Riyo Ueda, Takanobu Maekawa, Hirokazu Sakai & Akira Ishiguro

  2. Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan

    Osamu Nomura & Satoshi Nakagawa

  3. Department of Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan

    Satoshi Nakagawa & Akira Ishiguro

Authors
  1. Riyo Ueda
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  2. Osamu Nomura
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  3. Takanobu Maekawa
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  4. Hirokazu Sakai
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  5. Satoshi Nakagawa
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  6. Akira Ishiguro
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Corresponding author

Correspondence to Osamu Nomura.

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Funding

This study was supported by a grant from The Ministry of Health, Labor and Welfare of Japan to Satoshi Nakagawa.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Ethics Committee at the The National Center for Child Health and Development.

Additional information

Communicated by Mario Bianchetti

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Ueda, R., Nomura, O., Maekawa, T. et al. Independent risk factors for recurrence of apparent life-threatening events in infants. Eur J Pediatr 176, 443–448 (2017). https://doi.org/10.1007/s00431-017-2855-6

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  • DOI: https://doi.org/10.1007/s00431-017-2855-6

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