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

Bonkowsky, Joshua L.; Guenther, Elisabeth; Filloux, Francis; Srivastava, Rajendu

doi:10.1542/peds.2007-3376

Cited by 86 publications

(78 citation statements)

References 24 publications

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“…Neurology). 32 The ALTE literature supports that infants presenting with a lower-risk BRUE do not have an increased rate of cardiovascular or other events during admission and hospitalization may not be required, but close follow-up is recommended. Careful outpatient follow-up is advised (repeat clinical history and physical examination within 24 hours after the initial evaluation) to identify infants with ongoing medical concerns that would indicate further evaluation and treatment.…”

Section: A Clinicians Need Not Admit Infants Presenting With a Lowementioning

confidence: 99%

“…Although missing abusive head trauma can result in significant morbidity and mortality, the yield of performing neuroimaging to screen for abusive head trauma is extremely low and has associated risks of sedation and radiation exposure. 32,70 Unfortunately, the subtle presentation of child abuse may lead to a delayed diagnosis of abuse and result in significant morbidity and mortality. 70 In previously described ALTE cohorts, abnormal physical findings were associated with an increased risk of abusive head trauma.…”

Section: E Clinicians Should Not Obtain Anmentioning

confidence: 99%

“…The long-term risk of a diagnosis of neurologic disorders ranges from 3% to 11% in historical cohorts of ALTE patients. 2,32 One retrospective study in 243 ALTE patients reported that CNS imaging contributed to a neurologic diagnosis in 3% to 7% of patients. 4 However, the study population included all ALTEs, including those with a significant past medical history, nonwell-appearing infants, and those with tests ordered as part of the emergency department evaluation.…”

Section: A Clinicians Should Not Obtain Neuroimaging (Computed Tomomentioning

confidence: 99%

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Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Tieder¹,

Bonkowsky²,

Etzel³

et al. 2016

Pediatrics

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138

154

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This is the fi rst clinical practice guideline from the American Academy of Pediatrics that specifi cally applies to patients who have experienced an apparent life-threatening event (ALTE). This clinical practice guideline has 3 objectives. First, it recommends the replacement of the term ALTE with a new term, brief resolved unexplained event (BRUE). Second, it provides an approach to patient evaluation that is based on the risk that the infant will have a repeat event or has a serious underlying disorder. Finally, it provides management recommendations, or key action statements, for lower-risk infants. The term BRUE is defi ned as an event occurring in an infant younger than 1 year when the observer reports a sudden, brief, and now resolved episode of ≥1 of the following: (1) cyanosis or pallor; (2) absent, decreased, or irregular breathing; (3) marked change in tone (hyper-or hypotonia); and (4) altered level of responsiveness. A BRUE is diagnosed only when there is no explanation for a qualifying event after conducting an appropriate history and physical examination. By using this defi nition and framework, infants younger than 1 year who present with a BRUE are categorized either as (1) a lower-risk patient on the basis of history and physical examination for whom evidence-based recommendations for evaluation and management are offered or (2) a higher-risk patient whose history and physical examination suggest the need for further investigation and treatment but for whom recommendations are not offered. This clinical practice guideline is intended to foster a patient-and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient outcomes, support implementation, and provide direction for future research. Each key action statement indicates a level of evidence, the benefi t-harm relationship, and the strength of recommendation.

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Section: A Clinicians Need Not Admit Infants Presenting With a Lowementioning

confidence: 99%

Section: E Clinicians Should Not Obtain Anmentioning

confidence: 99%

Section: A Clinicians Should Not Obtain Neuroimaging (Computed Tomomentioning

confidence: 99%

See 1 more Smart Citation

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Tieder¹,

Bonkowsky²,

Etzel³

et al. 2016

Pediatrics

Self Cite

138

154

View full text Add to dashboard Cite

show abstract

“…Respiratory infections associated with HRV might play a major role in young infants, probably with few clinical signs, and might contribute to apnea as a first manifestation. GERD is the most frequent hospital discharge diagnosis in published series ( 5 , 11 ). For our patients, GERD also was the most frequent clinical diagnosis (9 patients), but for 7 of them, a respiratory virus was identified.…”

Section: Discussionmentioning

confidence: 99%

“…Apparently life-threatening events (ALTEs) in infants are associated with bronchiolitis or infections in up to 6% of patients by diagnosis after hospital admission ( 5 ). We assessed the relation between ALTEs and respiratory virus infection in a secondary hospital in Spain.…”

mentioning

confidence: 99%