Do All Infants With Apparent Life-Threatening Events Need to Be Admitted?

Claudius, Ilene; Keens, Thomas G.

doi:10.1542/peds.2006-2549

Cited by 74 publications

(55 citation statements)

References 18 publications

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“…Observational data indicate that 12% to 14% of infants presenting with a diagnosis of ALTE had a subsequent event or condition that required hospitalization. 7,31 Thus, research has sought to identify risk factors that could be used to identify infants likely to benefit from hospitalization. A long-term follow-up study in infants hospitalized with an ALTE showed that no infants subsequently had SIDS but 11% were victims of child abuse and 4.9% had adverse neurologic outcomes (see 3.…”

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

confidence: 99%

“…34 Preterm infants have been shown to have more serious events, although an ALTE does not further increase that risk compared with asymptomatic preterm infants without ALTE. 34 Claudius and Keens 31 performed an observational prospective study in 59 infants presenting with ALTE who had been born at >30 weeks' gestation and had no significant medical illness. They evaluated factors in the clinical history and physical examination that, according to the authors, would warrant hospital admission on the basis of adverse outcomes (including recurrent cardiorespiratory events, infection, child abuse, or any lifethreatening condition).…”

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

confidence: 99%

“…Several studies have documented intermittent episodes of hypoxemia after admission for ALTE. 7,31,33 Pulse oximetry identified more infants with concerning paroxysmal events than cardiorespiratory monitoring alone. 33 However, occasional oxygen desaturations are commonly observed in normal infants, especially during sleep.…”

Section: B Clinicians May Briefl Y Monitor Infants Presenting With mentioning

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

139

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: A Clinicians Need Not Admit Infants Presenting With a Lowementioning

confidence: 99%

Section: B Clinicians May Briefl Y Monitor Infants Presenting With mentioning

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

139

154

View full text Add to dashboard Cite

show abstract

“…Essa dificuldade deve-se, sobretudo, à não especificidade do evento, que pode ocorrer tanto em lactentes saudáveis, sem significado patológico, quanto como a primeira manifestação de uma grande variedade de doenças com gravidade variada 3,5,[7][8][9][10][11][13][14][15][16][17][18][19] .…”

Section: Introductionunclassified

“…Tal situação indica, obrigatoriamente, internação, observação rigorosa, monitoramento e investigação diagnóstica 2,6,9,12,16,19,20 .…”

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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Pediatric medical priorities

Gross

Fuchs

2015

Emergency Medical Services

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Do All Infants With Apparent Life-Threatening Events Need to Be Admitted?

Abstract: Our study suggests that >30-day-old infants who have experienced a single apparent life-threatening event may be discharged safely from the hospital, which would decrease admissions by 38%.

Cited by 74 publications

References 18 publications

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

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

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

Pediatric medical priorities

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