Death, Child Abuse, and Adverse Neurological Outcome of Infants After an Apparent Life-Threatening Event

Abstract

Infants who suffer an apparent life-threatening event are at risk for subsequent child abuse and adverse neurological outcomes. Deaths were uncommon and only occurred in the setting of severe developmental delay and seizure disorders. Neurological evaluation during hospitalization for a first apparent life-threatening event is of low yield, but close follow-up is essential.

Clues to Abusive Head Trauma in Infants with ALTE

“…1 This study confirms that the cornerstone of evaluating infants with ALTE remains the history and physical examination, and highlights the importance of a discrepant or changing story told by the parents or caretakers. They conclude that infants presenting to the ED with ALTE are at risk for AHT, even without specific examination abnormalities, and may be suspected by specific risk factors.…”

Clues to Abusive Head Trauma in Infants with ALTE

“…1 This study confirms that the cornerstone of evaluating infants with ALTE remains the history and physical examination, and highlights the importance of a discrepant or changing story told by the parents or caretakers. They conclude that infants presenting to the ED with ALTE are at risk for AHT, even without specific examination abnormalities, and may be suspected by specific risk factors.…”

Seizures In Children Following an Apparent Life-threatening Event

“…In contrast, the apparent life-threatening event cohort was evenly male and female. 7 Febrile seizures did occur in patients who had an apparent life-threatening event at a rate of 0.8%, which is lower than the reported rate of 2% to 5% for the general population. 11 Abnormal brain magnetic resonance imaging ðMRIÞ imaging results, and the occurrence of developmental delay, were only noted in the subgroup of patients with chronic epilepsy.…”

Use of Skeletal Surveys to Evaluate for Physical Abuse: Analysis of 703 Consecutive Skeletal Surveys

“…The relationship between ALTEs and child abuse is well documented, and the literature suggests that up to 10% of ALTEs may be attributable to abuse. [22][23][24][25] We caution, however, against making recommendations for changes in clinical practice on the basis of our findings; although the rate of positive SS results in this population was higher than expected, the proportion of children with ALTEs who underwent an SS was small. During the same 4-year time period as in the current study, 421 children were discharged from our ED with a diagnosis of ALTE.…”

Clues to Abusive Head Trauma in Infants with ALTE

“…1 This study confirms that the cornerstone of evaluating infants with ALTE remains the history and physical examination, and highlights the importance of a discrepant or changing story told by the parents or caretakers. They conclude that infants presenting to the ED with ALTE are at risk for AHT, even without specific examination abnormalities, and may be suspected by specific risk factors.…”

Seizures In Children Following an Apparent Life-threatening Event

“…In contrast, the apparent life-threatening event cohort was evenly male and female. 7 Febrile seizures did occur in patients who had an apparent life-threatening event at a rate of 0.8%, which is lower than the reported rate of 2% to 5% for the general population. 11 Abnormal brain magnetic resonance imaging ðMRIÞ imaging results, and the occurrence of developmental delay, were only noted in the subgroup of patients with chronic epilepsy.…”

Use of Skeletal Surveys to Evaluate for Physical Abuse: Analysis of 703 Consecutive Skeletal Surveys

“…The relationship between ALTEs and child abuse is well documented, and the literature suggests that up to 10% of ALTEs may be attributable to abuse. [22][23][24][25] We caution, however, against making recommendations for changes in clinical practice on the basis of our findings; although the rate of positive SS results in this population was higher than expected, the proportion of children with ALTEs who underwent an SS was small. During the same 4-year time period as in the current study, 421 children were discharged from our ED with a diagnosis of ALTE.…”

Clues to Abusive Head Trauma in Infants with ALTE

“…1 This study confirms that the cornerstone of evaluating infants with ALTE remains the history and physical examination, and highlights the importance of a discrepant or changing story told by the parents or caretakers. They conclude that infants presenting to the ED with ALTE are at risk for AHT, even without specific examination abnormalities, and may be suspected by specific risk factors.…”

Seizures In Children Following an Apparent Life-threatening Event

“…In contrast, the apparent life-threatening event cohort was evenly male and female. 7 Febrile seizures did occur in patients who had an apparent life-threatening event at a rate of 0.8%, which is lower than the reported rate of 2% to 5% for the general population. 11 Abnormal brain magnetic resonance imaging ðMRIÞ imaging results, and the occurrence of developmental delay, were only noted in the subgroup of patients with chronic epilepsy.…”

Use of Skeletal Surveys to Evaluate for Physical Abuse: Analysis of 703 Consecutive Skeletal Surveys

“…The relationship between ALTEs and child abuse is well documented, and the literature suggests that up to 10% of ALTEs may be attributable to abuse. [22][23][24][25] We caution, however, against making recommendations for changes in clinical practice on the basis of our findings; although the rate of positive SS results in this population was higher than expected, the proportion of children with ALTEs who underwent an SS was small. During the same 4-year time period as in the current study, 421 children were discharged from our ED with a diagnosis of ALTE.…”