Problems in Management of Infants with an Apparent Life‐Threatening Event<sup>a</sup>

Kahn, André; Rebuffat, Elisabeth; Sottiaux, Martine; Blum, Denise

doi:10.1111/j.1749-6632.1988.tb37235.x

Cited by 9 publications

(7 citation statements)

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“…Infants who have experienced an ALTE typically undergo extensive testing in the hospital, but 23% to 39% of them are nevertheless discharged without a diagnosis. [2][3][4] Each year, The Children's Hospital at Westchester Medical Center admits approximately 90 patients for evaluation following ALTEs. In 1995, several of these patients were discharged with diagnoses that had not initially been included in the differential diagnosis: shaken baby syndrome.…”

Section: Arch Pediatr Adolesc Med 2003;157:1011-1015mentioning

confidence: 99%

“…[7][8][9] The term apparent life-threatening event entered the medical literature in the late 1980s to distinguish it more clearly from sudden infant death syndrome, as it became evident that no definite link could be established. 2,3,10,11 In 1986, ALTE was officially defined by the National Institute of Child Health and Human Development. 1 Researchers have examined potential causes of ALTEs at the microscopic and macroscopic levels.…”

Section: Commentmentioning

confidence: 99%

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Abusive Head Injury as a Cause of Apparent Life-Threatening Events in Infancy

Altman

Brand²,

Forman³

et al. 2003

Arch Pediatr Adolesc Med

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A wide spectrum of diseases and disorders can precipitate an ALTE. Among them, abusive head injury, a recently recognized cause, occurs frequently enough to obligate its inclusion in the differential diagnosis. An ophthalmologic evaluation with dilated fundus examination and cranial imaging should therefore be considered early in the investigation unless another cause becomes apparent soon after admission.

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Section: Arch Pediatr Adolesc Med 2003;157:1011-1015mentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Abusive Head Injury as a Cause of Apparent Life-Threatening Events in Infancy

Altman

Brand²,

Forman³

et al. 2003

Arch Pediatr Adolesc Med

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“…Subsequent hospital work up failed to reveal a cause for the apparently life-threatening episode (ALTE). The detailed medical evaluation of these patients was described previously [10]. Another group of 50 infants was also studied.…”

Section: Offprint Requests To" a Kahnmentioning

confidence: 99%

Lack of temporal relation between acid reflux in the proximal oesophagus and cardiorespiratory events in sleeping infants

et al. 1992

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We studied sleeping infants in order to investigate whether a temporal relation exists between acid reflux extending to the proximal portion of the oesophagus and cardiorespiratory events. One hundred infants with occasional regurgitations were studied: 50 infants admitted after an apparently life-threatening event (ALTE) that occurred during sleep and that remained unexplained despite medical investigation, and 50 asymptomatic infants (non-ALTE). The infants had a median age of 8 weeks (range 4-26 weeks); 54 were boys. In each child a pH probe was placed in the proximal portion of the thoracic oesophagus, under radiological control. Polygraphic monitoring of state of alertness, cardiorespiratory activity, and proximal oesophageal pH changes was conducted continuously during 1 night. The data were analysed blind. In 80 infants a total of 186 decreases in oesophageal pH below 4 units were seen; 37% occurred during wakefulness, and 40% during rapid eye movement (REM) sleep. A total of 7029 central and 61 obstructive apnoeas were monitored, mainly during REM sleep. Within 5 min before, and 5 min after the drops in pH, there was no difference in the number, or the duration of bradycardia, central, mixed, or obstructive apnoea. The infants with an ALTE could not be differentiated from the non-ALTE infants for any of the variables studied. It is concluded that spontaneous acid refluxes extending to the proximal portion of the oesophagus during sleep are usually not temporally related with the development of apnoeas or bradycardias.

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“…9,10 Idiopathic hypertrophic pyloric stenosis is a recognized cause of metabolic alkalosis, but is not generally thought to be a cause of apnea-like events. 1,2 Although this is the first reported case to demonstrate clinically significant compensatory respiratory depression as the presenting complaint of IHPS, polysomnographic studies of infants with IHPS have previously shown increased frequency of respiratory pauses and apnea-related indices. 11,12 CONCLUSION Infants with IHPS should be monitored for the possibility of apnea until alkalosis improves.…”

Section: Discussionmentioning

confidence: 96%

“…1,2 Although aspiration of refluxed gastric contents from any cause may result in apnea through the stimulation of the laryngeal chemo reflex, 3 we believe that this case demonstrates central respiratory depression from the severe alkalosis caused by IHPS.…”

mentioning

confidence: 97%