Factors associated with infant death after apparent life-threatening event (ALTE)

Abstract

Objective: To detect factors associated with greater risk of death in infants after an apparent life-threatening event (ALTE). Methods:This cross-sectional, retrospective, descriptive and analytic study evaluated infants younger than 12 months who had a sudden event of cyanosis, pallor, hypotonia or apnea and were seen in the emergency department of a tertiary university hospital. Forward stepwise logistic regression (Wald) was used to calculate and adjust odds ratios to evaluate associations.Results: Mean age of the 145 patients included in the study was 105 days (median = 65 days). Eleven (7.6%) died, and their mean age was 189 days (median = 218 days). Mean age of survivors was 98 days (median = 62 days) (p = 0.003). Activity before the event, prematurity and number of events were not associated with death. A significant association was found with pallor. Of the 11 infants, 3 had spontaneous resolution of ALTE, whereas 8 patients [27.6%; p < 0.001; OR = 14.3 (95%CI 3.51-58.3)] did not. The associations with respiratory or cardiovascular disease were also significant. In multivariate analysis, immediate spontaneous resolution [p = 0.015; OR = 6.06 (95%CI 1.02-35.94)] and diagnosis of cardiovascular disease [p = 0.047; OR = 164.27 (95%CI 7.34-3.673.78)] remained statistically significant. Conclusion:Infants who experienced an ALTE had a higher risk of subsequent death when their age was greater than 6 months and the event had a long duration, particularly when ALTE was associated with cardiovascular disease.J Pediatr (Rio J). 2010;86(6):515-519: ALTE, apparent-life threatening event, death risk, infants. ResumoObjetivo: Identificar, na admissão dos lactentes com após eventos com aparente risco de morte (apparent life-threatening event, ALTE), fatores que possam indicar maior risco de evolução para o óbito.Métodos: Estudo transversal retrospectivo, descritivo e analítico com lactentes menores de 12 meses, com evento súbito de cianose, palidez, hipotonia e/ou apneia, atendidos na unidade de emergência de hospital universitário de nível terciário. Para avaliação da associação, determinaram-se os valores de odds ratio bruto e ajustado por regressão logística (método stepwise forward Wald). Resultados:Foram avaliados 145 pacientes com idade média de 105 dias (mediana = 65 dias). Onze (7,6%) evoluíram para óbito, com idade média de 189 dias (mediana = 218 dias), enquanto que a idade média dos sobreviventes foi de 98 dias (mediana = 62 dias) (p = 0,003). Atividades que precederam o evento, antecedente de prematuridade e número de episódios não apresentaram associação com o óbito. Apresentou relação significativa o relato de palidez pelos observadores. Entre os 11 lactentes, 3 apresentaram melhora imediata e espontânea; já 8 pacientes [27,6%; p < 0,001; OR = 14,3 (IC95% 3,51-58,3)] não tiveram melhora espontânea. Os diagnósticos de doença do trato respiratório e do sistema cardiocirculatório também foram significantes. Na análise multivariada, mostraram significância estatística: não melhora imediata e espontân...

Evento com aparente risco de morte: uma revisão

“…In general, ALTE episodes are of short duration, lasting less than 5 minutes, and recovery is complete and spontaneous (17,19,27) . The majority of infants are taken to emergency services by their carers immediately after their first event (7,19,22) . Notwithstanding, many (44 to 46.5%) are only taken to health services after two or more episodes (7,22) .…”

“…The conference was organized in response to the dilemma caused by the difficulty of defining the differences between ALTE, Sudden Infant Death Syndrome (SIDS) and apnea of infancy, even though the lack of pathophysiologic correlations means distinctions are obligatory (1)(2)(3)(4) . In Portuguese, terms that back-translate as "event possibly threatening life" (episódio de possível ameaça à vida), "event apparently involving risk to life" (evento com aparente risco de vida)" and "event apparently involving risk of death" (evento com aparente risco de morte) have been used as translations of the English term "apparent life-threatening event" (5)(6)(7) .…”

Evento com aparente risco de morte recorrente como manifestação inicial de síndrome miastênica congênita

“…Apparent life-threatening events (ALTE) are defined as frightening episodes to the observer, characterized by a combination of apnea (central or obstructive), change in skin color (cyanotic or pallid), change in the muscle tone (hypotonia), choke, or gag reflex (1,2) . The occurrence of an ALTE in healthy infants is not an infrequent fact, usually as a single event, with short time duration and with complete and spontaneous resolution (2,3) .…”

“…The occurrence of an ALTE in healthy infants is not an infrequent fact, usually as a single event, with short time duration and with complete and spontaneous resolution (2,3) . However, although most of the events have no pathological meaning and have benign course, the ALTE may be associated with a variety of underlying diseases (2)(3)(4)(5)(6)(7)(8)(9)(10) .…”

“…The occurrence of an ALTE in healthy infants is not an infrequent fact, usually as a single event, with short time duration and with complete and spontaneous resolution (2,3) . However, although most of the events have no pathological meaning and have benign course, the ALTE may be associated with a variety of underlying diseases (2)(3)(4)(5)(6)(7)(8)(9)(10) . Some infants exhibit recurrence of the signs and symptoms of ALTE, with progressively more severe clinical presentation compared to the initial event, which raises the risk of subsequent morbidity and mortality associated with the event itself or with the disease that caused it (3)(4)(5)(6)(7)(8)(9) .…”