Apparent Life-Threatening Event: A Review

DeWolfe, Craig

doi:10.1016/j.pcl.2005.05.004

Cited by 65 publications

(74 citation statements)

References 47 publications

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“…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) .…”

Section: Introductionmentioning

confidence: 99%

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

Romaneli

Castro

Fraga

et al. 2013

Rev. paul. pediatr.

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Objective: To alert pediatricians about the importance of a careful investigation on recurrent apparent life-threatening events. Reports of the association of these events with congenital myasthenic syndromes were not found.Case description: A seven-month-old infant with recurrent apparent life-threatening events was admitted for investigation. During hospital stay, she presented cyanosis and respiratory failure, requiring mechanical ventilation for three days. After clinical improvement, hypotheses of gastroesophageal reflux and pulmonary aspiration were ruled out. The presence of eyelid ptosis, general hypotonia and weak crying led to the suspicion of congenital myasthenia, which was confirmed. Treatment with oral piridostigmine led to neurological and nutritional normalization, without any other apparent life-threatening event during the next three years.Comments: The careful etiological investigation of apparent life-threatening events may lead to rare diagnosis that requires specific treatments, such as congenital myasthenia.Key-words: infantile apparent life-threatening event; myasthenia gravis; muscle hypotonia; apnea; infant. RESUMOObjetivo: Alertar os pediatras sobre a necessidade de investigar criteriosamente a etiologia de eventos com aparente risco de morte recorrente. Não foram encontrados relatos associando tais eventos à miastenia congênita.Descrição do caso: Lactente de sete meses apresentando história de eventos com aparente risco de morte recorrente foi internado para investigação. Durante a internação, apresentou cianose e dispneia progressiva, com necessidade de ventilação mecânica por três dias. Após a melhora clínica, e tendo sido descartadas as hipóteses de doença do refluxo gastroesofágico e aspiração pulmonar como desencadeantes, notou-se ptose palpebral bilateral, hipotonia apendicular e choro fraco, que conduziram à suspeita clínica de miastenia congênita. Após confirmação do diagnóstico, foi mantido tratamento ambulatorial com piridostigmina, com recuperação nutricional e neurológica, sem novos eventos com aparente risco de morte nos três anos seguintes.Comentários: A investigação minuciosa das causas de eventos com aparente risco de morte pode levar a diagnósticos menos frequentes que exigem tratamento específico, como a miastenia congênita.Palavras-chave: evento com aparente risco de vida infantil; miastenia gravis; hipotonia muscular; apneia; lactente. Evento com aparente risco de morte recorrente como manifestação inicial de síndrome miastênica congênita RESUMEN Objetivo: Alertar a los pediatras sobre la necesidad de investigar criteriosamente la etiología de eventos con aparente riesgo de muerte recurrente. No se encontraron relatos asociando tales eventos a la miastenia congénita.Descripción del caso: Lactante de siete meses presentando historia de eventos con aparente riesgo de muerte recurrente fue internado para investigación. Durante la internación, presentó cianosis y disnea progresiva, con necesidad de ventilación mecánica por tres días. Después de la mejora clínic...

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Section: Introductionmentioning

confidence: 99%

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

Romaneli

Castro

Fraga

et al. 2013

Rev. paul. pediatr.

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“…Sua ocorrência, sem causa aparente em lactentes considerados saudáveis, não é um fato infrequente, geralmente cursando com evolução benigna. Porém, o risco de mortalidade subsequente existe e deve ser considerado [2][3][4][5][6] .…”

Section: Introductionunclassified

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

Romaneli¹,

Fraga²,

Morcillo³

et al. 2010

J Pediatr (Rio J)

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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...

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“…These episodes can potentially lead to significant multisystem morbidity, such as poor neurodevelopment, retinopathy of prematurity, and impaired growth (3)(4)(5). In older infants, apneic episodes are associated with apparent life-threatening events (6,7). Interestingly, the incidence rate of sudden infant death syndrome declined from 142.9 to 54.6 deaths per 100,000 live births between 1984 and 2004 (8).…”

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confidence: 99%

Real-time detection, classification, and quantification of apneic episodes using miniature surface motion sensors in rats

et al. 2015

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Background: Real-time detection and classification of apneic episodes remain significant challenges. This study explores the applicability of a novel method of monitoring the respiratory effort and dynamics for rapid detection and classification of apneic episodes. Methods: Obstructive apnea (OA) and hypopnea/central apnea (CA) were induced in nine tracheostomized rats, by short-lived airway obstruction and administration of succinylcholine, respectively. Esophageal pressure (EP), EtCO 2 , arterial O 2 saturation (SpO 2 ), heart rate, and blood pressure were monitored. Respiratory dynamics were monitored utilizing three miniature motion sensors placed on the chest and epigastrium. Three indices were derived from these sensors: amplitude of the tidal chest wall displacement (TDi), breath time length (BTL), that included inspiration and rapid expiration phases, and amplitude time integral (ATI), the integral of breath amplitude over time. results: OA induced a progressive 6.42 ± 3.48-fold increase in EP from baseline, which paralleled a 3.04 ± 1.19-fold increase in TDi (P < 0.0012), a 1.39 ± 0.22-fold increase in BTL (P < 0.0002), and a 3.32 ± 1.40-fold rise in the ATI (P < 0.024). During central hypopneic/apneic episodes, each sensor revealed a gradual decrease in TDi, which culminated in absence of breathing attempts. conclusion: Noninvasive monitoring of chest wall dynamics enables detection and classification of central and obstructive apneic episodes, which tightly correlates with the EP.

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Apparent Life-Threatening Event: A Review

Cited by 65 publications

References 47 publications

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

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

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

Real-time detection, classification, and quantification of apneic episodes using miniature surface motion sensors in rats

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