This retrospective study aims at helping physicians select babies considered at risk for fatal events during sleep. It does so by describing the clinical features and outcome of worrying infants’ behaviour during sleep, with the activation of an emergency medical service and/or emergency department, subsequently referred to the Centre for Paediatric Sleep Medicine and sudden infant death syndrome, Regina Margherita Children’s Hospital, Turin, Italy. We analysed the medical records of infants < 12 months whose parents reported they had worrying behaviour during sleep in the period 1 January 2009– 31 December 2015. Regional guidelines suggest performing anamnesis and capillary blood gas analysis in case of apparent life-threatening events. There were 33 males, average age 55 ± 54.37 days. On arrival at the emergency medical service/emergency department 97 % infants were asymptomatic; 61 % patients had a capillary blood gas analysis as suggested by the regional guidelines. A clear acid-base disorder was observed in two infants, asymptomatic at medical evaluation, that had assumed an unsafe sleeping position. Two patients presented recurrence of the episode at 3 months.
Conclusions: Most worrying infant behaviour during sleep can be related to paraphysiological phenomena; capillary blood gas analysis and anamnesis are pivotal to identify the cases at risk of fatal events.
|What is Known:|
• Events that happen during sleep often frighten the parents of newborns. This fear may be induced by the fact that Sudden Infant Death Syndrome typically occurs during sleep.
• This tragic event is unpredictable by any clinical features or findings in instrumental examinations and cannot be prevented with an early resuscitation.
|What is New:|
• In our retrospective study, most worrying infant behaviour during sleep can be related to paraphysiological phenomena.
• Capillary blood gas analysis and anamnesis collection were crucial to identify the only two life-threatening events.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
American Academy of Pediatrics
Apparent life-threatening events
Brief resolved unexplained event
Capillary blood gas analysis
Emergency medical services
Sudden infant death syndrome
Barrington KJ, Finer NN (1990) Periodic breathing and apnea in preterm infants. Pediatr Res 27:118–121
Bonafide CP, Jamison DT, Foglia E (2017) The emerging market of smartphone-integrate infant physiologic monitors. JAMA 317:353–354
Brand DA, Fazzari MJ (2018) Risk of death in infants who have experienced a brief resolved unexplained event: a meta-analysis. J Pediatr 197:63–67
Carroll JL (2004) Apparent life threatening event (ALTE) assessment. Pediatr Pulmonol 37:108–109
Fenner A, Schalk U, Hoenicke H, Wendenburg A, Roehling T (1973) Periodic breathing in premature and neonatal babies: incidence, breathing pattern, respiratory gas tensions, response to changes in the composition of ambient air. Pediatr Res 7:174–183
Fleming PJ, Blair PS, Pease A (2015) Sudden unexpected death in infancy: aetiology, pathophysiology, epidemiology and prevention in 2015. Arch Dis Child 100:984–988
Goldaber KG, Gilstrap LC (1993) Correlations between clinical events and umbilical cord blood acid-base and blood gas values. Clin Obstet Gynecol 36:47–59
Grigg-Damberger MM (2016) The visual scoring of sleep in infants 0 to 2 months of age. J Clin Sleep Med 12:429–445
Horne RSC, Nixon GM (2014) The role of physiological studies and apnoea monitoring in infants. Paediatr Respir Rev 4:312–318
Kahn A (2004) 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. Eur J Pediatr 163:108–115
Kinney HC, Thach BT (2009) The sudden infant death syndrome. NEJM 361:795–805
Krous HF, Haas EA, Chadwick AE, Masoumi H, Mhoyan A, Stanley C (2008) Delayed death in sudden infant death syndrome: a San Diego SIDS/SUDC Research Project 15-year population-based report. Forensic Sci Int 176:209–216
MacLean JE, Fitzgerald D, Waters KA (2015) Developmental changes in sleep and breathing across infancy and childhood. Paediatr Resp Rev 16:276–284
Mitchell E, Thompson J (2001) Parental reported apnoea, admissions to hospital and sudden infant death syndrome. Acta Paediatr 90:417–422
Moon RY, AAP TASK FORCE ON SUDDEN INFANT DEATH SYNDROME (2016) SIDS and other sleep-related infant deaths: evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics 138:e20162940
National Institutes of Health Consensus (1987) Development Conference on Infantile Apnea and Home Monitoring, Sept 29 to Oct 1, 1986. Pediatrics 79(2):292–299
Patel M, Mohr M, Lake D, Delos J, Randall Moorman J, Sinkin RA, Kattwinke J, Fairchild K (2016) Clinical associations with immature breathing in preterm infants: part 2: periodic breathing. Pediatr Res 80:28–34
Ramanathan R, Corwin MJ, Hunt CE et al (2001) Cardiorespiratory events recorded on home monitors: comparison of healthy infants with those at increased risk for SIDS. JAMA 285:2199–2207
Tieder JS, Bonkowsky JL, Etzel RA, Franklin WH, Gremse DA, Herman B, Katz ES, Krilov LR, Merritt JL, Norlin C, Percelay J, Sapien RE, Shiffman RN, Smith MBH, for the SUBCOMMITTEE ON APPARENT LIFE THREATENING EVENTS (2016) Brief resolved unexplained events (formerly apparent life-threatening events) and evaluation of lower-risk infants. Pediatrics 137:e20160590
Uslu S, Bulbul A, Cana E, Zubarioglub U, Salihogluc O, Nuhoglua A (2012) Relationship between oxygen saturation and umbilical cord pH immediately after birth. Pediatr Neonatal 53:340–345
Vigo A, Noce S, Ravaglia A (2015) Per una corretta gestione del bambino con ALTE. Medico e Bambino 34:292–297
Vigo A, Balagna R, Brazzi L, Costagliola G, Gregoretti C, Lupica MM, Noce S (2018) Apparent life-threatening events: helping infants help themselves. Pediatr Emerg Care 34:545–551
In loving memory of Dr. Elisa Ferrero, who analysed the data, wrote the initial draft of the manuscript and could not see the final version of the work as she flew away too early.
The authors thank Barbara Wade, contract professor of English at the University of Torino, for her linguistic advice.
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in compliance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Communicated by Mario Bianchetti
About this article
Cite this article
Vigo, A., Noce, S., Costagliola, G. et al. Sleep-related risk and worrying behaviours: a retrospective review of a tertiary centre’s experience. Eur J Pediatr 178, 1841–1847 (2019). https://doi.org/10.1007/s00431-019-03460-2
- Cardiorespiratory monitor
- Capillary blood gas analysis