Management of Apparent Life-Threatening Events in Infants: A Systematic Review

Tieder, Joel S.; Altman, Robin; Bonkowsky, Joshua L.; Brand, Donald A.; Claudius, Ilene; Cunningham, Diana J.; DeWolfe, Craig; Percelay, Jack M.; Pitetti, Raymond D.; Smith, Michael

doi:10.1016/j.pepo.2014.04.008

Cited by 5 publications

(13 citation statements)

References 54 publications

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“…3 As a result, the clinician is often faced with several dilemmas. First, under the ALTE definition, the infant is often, but not necessarily, asymptomatic on presentation.…”

Section: Change In Terminology and Diagnosismentioning

confidence: 99%

“…Although this risk has been difficult to quantify historically and no studies have fully evaluated patient-centered outcomes (eg, family experience survey), the systematic review of the ALTE literature identified a subset of BRUE patients who are unlikely to have a recurrent event or undiagnosed serious conditions, are at lower risk of adverse outcomes, and can likely be managed safely without extensive diagnostic evaluation or hospitalization. 3 In the systematic review of ALTE studies in which it was possible to identify BRUE patients, the following characteristics most consistently conferred higher risk: infants <2 months of age, those with a history of prematurity, and those with more than 1 event. There was generally an increased risk from prematurity in infants born at <32 weeks' gestation, and the risk attenuated once infants born at <32 weeks' gestation reached 45 weeks' postconceptional age.…”

Section: Risk Assessment: Lower-versus Higher-risk Bruementioning

confidence: 99%

“…2 Although the definition of ALTE eventually enabled researchers to establish that these events are separate entities from SIDS, the clinical application of this classification, which describes a constellation of observed, subjective, and nonspecific symptoms, has raised significant challenges for clinicians and parents in the evaluation and care of these infants. 3 Although a broad range of disorders can present as an ALTE (eg, child abuse, congenital abnormalities, epilepsy, inborn errors of metabolism, and infections), for a majority of infants who appear well after the event, the risk of a serious underlying disorder or a recurrent event is extremely low. 2 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…3 As a result, the clinician is often faced with several dilemmas. First, under the ALTE definition, the infant is often, but not necessarily, asymptomatic on presentation.…”

Section: Change In Terminology and Diagnosismentioning

confidence: 99%

Section: Risk Assessment: Lower-versus Higher-risk Bruementioning

confidence: 99%

Section: Introductionmentioning

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

“…2 Although the definition of ALTE enabled researchers to establish over time that these events were a separate entity from SIDS, the clinical application of this classification, which describes a constellation of observed, subjective, and nonspecific symptoms, has raised significant challenges for clinicians and parents in the evaluation and care of these infants. 3 Although a broad range of disorders can present as an ALTE (eg, child abuse, congenital abnormalities, epilepsy, inborn errors of metabolism, and infections), for a majority of well-appearing infants, the risk of a recurrent event or a serious underlying disorder is extremely low.…”

mentioning

confidence: 99%

“…A recent systematic review of nearly 1400 ALTE publications spanning 4 decades concluded that risk of a subsequent or underlying disorder could not be quantified because of the variability in case definitions across studies. 3 Although there are history and physical examination factors that can determine lower or higher risk, it is clear that the term ALTE must be replaced to advance the quality of care and improve research.…”

mentioning

confidence: 99%