Home Cardiorespiratory Monitoring in Infants at Risk for Sudden Infant Death Syndrome (SIDS), Apparent Life-Threatening Event (ALTE) or Brief Resolved Unexplained Event (BRUE)

Abstract

Sudden infant death syndrome (SIDS) is defined as the sudden death of an infant younger than one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history. About 90% of SIDS occur before six months of age, the peak incidence is between two and four months, and the median age for death is elven weeks. The clinical, social, and economic relevance of SIDS, together with the evidence that prevention of this syndrome was possible, has significantly stimulated research into risk factors for the development of SIDS in the hope of being able to introduce new effective preventive measures. This narrative review discusses the potential relationships between apparent life-threatening events (ALTE) or brief resolved unexplained events (BRUE) and SIDS development, and when a home cardiorespiratory monitor is useful for prevention of these conditions. A literature analysis showed that home cardiorespiratory monitoring has been considered a potential method to identify not only ALTE and BRUE but SIDS also. ALTE and BRUE are generally due to underlying conditions that are not detectable in SIDS infants. A true relationship between these conditions has never been demonstrated. Use of home cardiorespiratory monitor is not recommended for SIDS, whereas it could be suggested for children with previous ALTE or severe BRUE or who are at risk of the development of these conditions. However, use of home cardiorespiratory monitors assumes that family members know the advantages and limitations of these devices after adequate education and instruction in their use.

Sudden Infant Death Syndrome (SIDS): State of the Art and Future Directions

“…Molecular understanding of intrinsic risk factors involves addressing ethical concerns, the lack of progress in identifying causes, and utilizing advanced techniques like next-generation DNA sequencing (NGS) for genetic diagnosis [14,45,113,114]. NGS techniques, including short-read and long-read sequencing, play a fundamental role in detecting genetic defects related to SIDS [115]. During the fetal stage, tests such as ultrasonography, electrocardiography, echocardiography, and magnetocardiography can be performed to monitor heart development and detect potential issues [116][117][118][119][120].…”

An approach to common sleep presentations in infants and toddlers

“…12 There remains no evidence to support the routine use of infant cardiorespiratory monitors to prevent SUDI. 13 In 2016, the term 'apparent life-threatening event' (ALTE) was largely replaced by 'brief resolved unexplained event' (BRUE). 14 A BRUE is defined as an event in which the observer notes one or more of the signs of cyanosis, pallor, breathing cessation/decrease/irregularity, marked change in tone or altered level of responsiveness occurring for a period of less than one minute and then resolving to baseline in a child <12 months of age without a known causative medical condition, with subsequent medical evaluation resulting in a reassuring history, physical examination and vital signs.…”

“…14 BRUEs have not been found to be precursor events to SUDI; instead, they have various possible causes, including cardiac and metabolic conditions, inflicted injury and infections. 13,15 Most often, no clear cause is found, and perhaps exaggerated airway reflexes in the setting of feeding, reflux or nasopharyngeal secretions are the reason for the event. 16 BRUEs can occur during awake or sleep states.…”

“…International expert consensus supports a case-by-case consideration for home cardiorespiratory monitoring for high-risk preterm infants and those presenting with severe or recurrent ALTEs or BRUEs. 13 Specialist referral for such cases is appropriate.…”