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Apparent Life-Threatening Event (ALTE) in Infants with Esophageal Atresia

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Esophageal and Gastric Disorders in Infancy and Childhood

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Abstract

This is a review of present knowledge on ALTE in infants with esophageal atresia 65 years after its first report. Three different clinical presentations have been described. The most frequent form is characterized by recurrent episodes of upper airway obstruction followed by a sudden respiratory arrest. The second clinical presentation is characterized by sudden respiratory arrest not associated with signs of airways obstruction. The third form is characterized by a severe bradycardia not associated with apnea and followed by cardiac arrest. A maturational dysautonomia affecting respiratory and cardiac rhythm regulation appears to play an important pathogenetic role. ALTE may progress to sudden death; therefore, it requires treatment. Underlying disorders currently considered to be surgically correctable causes of ALTE include gastroesophageal reflux, tracheomalacia, and upper airway instability.

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References

  1. Robin P. La chute de la base de la langue consideree comme une nouvelle cause de gene dans la respiration nasopharyngienne. Bull Acad. 1923;89:37–41.

    Google Scholar 

  2. Haight C. Congenital atresia of the esophagus with tracheoesophageal fistula: reconstruction of esophageal continuity by primary anastomosis. Ann Surg. 1944;120:623–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Schwartz L. Congenital laryngeal stridor (inspiratory laryngeal collapse). Arch Otolaryng. 1944;39:403–12.

    Article  Google Scholar 

  4. Mercer RD. Laryngeal stridor with temporary cardiac and respiratory arrest. Ann J Dis Child. 1945;70:336.

    Article  Google Scholar 

  5. Douglas B. The treatment of micrognathia associated with obstruction by a plastic procedure. Plast Reconstr Surg. 1946;1:300–8.

    Article  CAS  Google Scholar 

  6. Routledge RT. The Pierre-Robin syndrome: a surgical emergency in the neonatal period. Br J Plast Surg. 1960;13:204–18.

    Article  CAS  PubMed  Google Scholar 

  7. Cozzi F. Glossoptosis as cause of apnoeic spells in infants with choanal atresia. Lancet. 1977;II:830–1.

    Article  Google Scholar 

  8. Newton-John H. Pulmonary edema upper airway obstruction. Lancet. 1977;II:510.

    Article  Google Scholar 

  9. Johnson P. Prolonged expiratory apnoea and implications for control of breathing. Lancet. 1985;II:877–9.

    Article  Google Scholar 

  10. Booker PD, Bush GH. Neonatal respiratory physiology and respiratory complication. In: Lister J, Irving IM, editors. Neonatal surgery. London: Butterworths; 1990.

    Google Scholar 

  11. National Institutes of Health Consensus Development Conference on infantile Apnea and Home Monitoring, Sept 29 to Oct 1, 1986. Consensus statement. Pediatrics. 1987;79:292–9.

    Google Scholar 

  12. Southall DP. Role of apnea in the sudden infant death syndrome: a personal view. Pediatrics. 1988;81:73–84.

    CAS  PubMed  Google Scholar 

  13. Costigan DC, Newth CJ. Respiratory status of children with epiglottitis with and without an artificial airway. Am J Dis Child. 1983;137:139–41.

    CAS  PubMed  Google Scholar 

  14. Cozzi F, Pierro A. Glossoptosis-apnea syndrome in infancy. Pediatrics. 1985;75:836–43.

    CAS  PubMed  Google Scholar 

  15. Cozzi F, Wilkinson AW. Oesophageal atresia. Lancet. 1967;II:1222–5.

    Article  Google Scholar 

  16. Fearon B, Shortreed R. Tracheobronchial compression by congenital cardiovascular anomalies in children. Syndrome of apnea. Ann Otol Rhinol Laryngol. 1963;72:949–69.

    Article  CAS  PubMed  Google Scholar 

  17. Cozzi F, Wilkinson AW. Mortality in oesophageal atresia. J R Coll Surg Edinb. 1975;20:236–43.

    Google Scholar 

  18. Schwartz MZ, Filler RM. Tracheal compression as a cause of apnea following repair of tracheoesophageal fistula: treatment by aortopexy. J Pediatr Surg. 1980;15:842–8.

    Article  CAS  PubMed  Google Scholar 

  19. Malone PS, Kiely EM. Role of aortopexy in the management of primary tracheomalacia and tracheobronchomalacia. Arch Dis Child. 1990;65:438–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Allen RJ, Toesley HA, Wilson JL. Neurogenic stridor in infancy. AMA Am J Dis Child. 1954;87:179–91.

    CAS  PubMed  Google Scholar 

  21. Bauer CH, Engle MA, Mellins R. Hypervagism and cardiac arrest. Bull N Y Acad Med. 1959;35:260–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Wittenborg MH, Gyepes MT, Crocker D. Tracheal dynamics in infants with respiratory distress, stridor, and collapsing trachea. Radiology. 1967;88:653–62.

    Article  CAS  PubMed  Google Scholar 

  23. Kenisberg K, Boris M, Joseph P, et al. Reflex bradycardia after tracheoesophageal fistula repair. Surgery. 1972;71:125–9.

    Google Scholar 

  24. Newth CJL, Levison H, Bryan AC. The respiratory status of children with croup. J Pediatr. 1972;81:1068–73.

    Article  CAS  PubMed  Google Scholar 

  25. Chignol A, Cloup M, Binet JP, et al. Association d’atresie de l’oesophage, de tracheomalacie et de tronc arteriel brachiocephalique anormal. Ann Pediatr. 1975;2:45–52.

    Google Scholar 

  26. Benjamin B, Cohen D, Glasson M. Tracheomalacia in association with congenital tracheoesophageal fistula. Surgery. 1976;79:504–8.

    CAS  PubMed  Google Scholar 

  27. Filler RM, Rossello PJ, Lebowitz RL. Life-threatening anoxic spells caused by tracheal compression after repair of esophageal atresia: correction by surgery. J Pediatr Surg. 1976;11:739–48.

    Article  CAS  PubMed  Google Scholar 

  28. Sauvegrain J, Bohu D, Lallemand D. Esophageal atresia, brachio-cephalic arterial trunk and tracheomalacia. J Radiol Electrol Med Nucl. 1976;57:465–70.

    CAS  PubMed  Google Scholar 

  29. Leape LL, Holder TM, Franklin JD, et al. Respiratory arrest in infants secondary to gastroesophageal reflux. Pediatrics. 1977;60:924–8.

    CAS  PubMed  Google Scholar 

  30. Coryllos E, Delaney T, Reitman M, et al. Selective denervation of the S-A node in the treatment of progressive central vagal bradycardia. J Pediatr Surg. 1984;1984(19):451–6.

    Article  Google Scholar 

  31. Southall DP, Talbert DG, Johnson P, et al. Prolonged expiratory apnoea: a disorder resulting in episodes of severe arterial hypoxaemia in infants and young children. Lancet. 1985;II:571–7.

    Article  Google Scholar 

  32. Blair GK, Cohen R, Filler RM. Treatment of tracheomalacia: eight years’ experience. J Pediatr Surg. 1986;21:781–5.

    Article  CAS  PubMed  Google Scholar 

  33. Spitz L, Kiely E, Brereton RJ. Esophageal atresia: five year experience with 148 cases. J Pediatr Surg. 1987;22:103–8.

    Article  CAS  PubMed  Google Scholar 

  34. Southall DP, Stebbens V, Shinebourne EA. Sudden and unexpected death between 1 and 5 years. Arch Dis Child. 1987;62:700–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Southall DP, Stebbens VA, Rees SV, et al. Apnoeic episodes induced by smothering: two cases identified by covert video surveillance. Br Med J. 1987;294:1637–41.

    Article  CAS  Google Scholar 

  36. Southall DP, Samuels MP, Talbert DG. Recurrent cyanotic episodes with severe arterial hypoxaemia and intrapulmonary shunting: a mechanism for sudden death. Arch Dis Child. 1990;65:953–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Cozzi F, Myers NA, Madonna L, et al. Esophageal atresia, choanal atresia, and dysautonomia. J Pediatr Surg. 1991;26:548–52.

    Article  CAS  PubMed  Google Scholar 

  38. Filler RM, Messineo A, Vinograd I. Severe tracheomalacia associated with esophageal atresia: results of surgical treatment. J Pediatr Surg. 1992;27:1136–40.

    Article  CAS  PubMed  Google Scholar 

  39. Corbally MT, Spitz L, Kiely E, et al. Aortopexy for tracheomalacia in oesophageal anomalies. Eur J Pediatr Surg. 1993;3:264–6.

    Article  CAS  PubMed  Google Scholar 

  40. Kazerooni NL, VanCamp J, Hirschl RB, et al. Fundoplication in 160 children under 2 years of age. J Pediatr Surg. 1994;29:677–81.

    Article  CAS  PubMed  Google Scholar 

  41. Cozzi F, Bonanni M, Cozzi DA, et al. Assessment of pulmonary mechanics and breathing patterns during posturally induced glossoptosis in infants. Arch Dis Child. 1996;74:512–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Cozzi DA, Bonanni M, Cozzi F, et al. Recurrent apparent life-threatening event relieved by glossopexy. J Pediatr Surg. 1996;31:1715–8.

    Article  CAS  PubMed  Google Scholar 

  43. Kubiak R, Spitz L, Kiely EM, et al. Effectiveness of fundoplication in early infancy. J Pediatr Surg. 1999;34:295–9.

    Article  CAS  PubMed  Google Scholar 

  44. Cozzi DA, Capocaccia P, Roggini M, et al. Respiratory status of infants with esophageal atresia. Pediatr Surg Int. 2001;17:92–6.

    Article  CAS  PubMed  Google Scholar 

  45. Cozzi F, Morini F, Casati A, et al. Glossopexy as an alternative to aortopexy in infants with repaired esophageal atresia and upper airway obstruction. J Pediatr Surg. 2002;37:202–6.

    Article  PubMed  Google Scholar 

  46. Deurloo JA, Ekkelkamp S, Schoorl M et al. Esophageal atresia: historical evolution of management and results in 371 patients. Ann Thorac Surg. 2002;73:267–72.

    Google Scholar 

  47. Nasr A, Ein SH, Gerstle JT. Infants with repaired esophageal atresia and distal tracheoesophageal fistula with severe respiratory distress: is it tracheomalacia, reflux, or both? J Pediatr Surg. 2005;40:901–3.

    Article  PubMed  Google Scholar 

  48. Cozzi DA, Zani A, Conforti A, et al. Pathogenesis of apparent life-threatening events in infants with esophageal atresia. Pediatr Pulmonol. 2006;41:488–93.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We wish to thank Dr. S. Frediani for his help and comments in the preparation of this chapter.

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Authors and Affiliations

  1. Pediatric Surgery Unit, University of Rome “La Sapienza”, Azienda Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy

    Francesco Cozzi MD & Denis A. Cozzi MD

Authors
  1. Francesco Cozzi MD
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  2. Denis A. Cozzi MD
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Correspondence to Francesco Cozzi MD .

Editor information

Editors and Affiliations

  1. Medical University of Graz, Graz, Austria

    Holger Till

  2. Sheffield Children’s Hospital, Paediatric Gastroenterology Centre, Sheffield, United Kingdom

    Mike Thomson

  3. Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA

    John E. Foker

  4. Department Surgery, University of Missouri, Kansas City Children’s Mercy Hospital, Kansas City, Missouri, USA

    George W. Holcomb III

  5. University of Arizona, Tucson, Arizona, USA

    Khalid M. Khan

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Cozzi, F., Cozzi, D.A. (2017). Apparent Life-Threatening Event (ALTE) in Infants with Esophageal Atresia. In: Till, H., Thomson, M., Foker, J., Holcomb III, G., Khan, K. (eds) Esophageal and Gastric Disorders in Infancy and Childhood. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-11202-7_46

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  • DOI: https://doi.org/10.1007/978-3-642-11202-7_46

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  • Online ISBN: 978-3-642-11202-7

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