Apparent life-threatening event in infants
- Michael J Corwin, MD
Michael J Corwin, MD
- Associate Professor of Pediatrics and Epidemiology
- Boston University Schools of Medicine and Public Health
- Section Editors
- George B Mallory, MD
George B Mallory, MD
- Section Editor — Pediatric Pulmonology
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Stephen J Teach, MD, MPH
Stephen J Teach, MD, MPH
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics and Emergency Medicine
- George Washington University School of Medicine and Health Sciences
- Teresa K Duryea, MD
Teresa K Duryea, MD
- Section Editor — General Pediatrics
- Associate Professor of Pediatrics
- Baylor College of Medicine
An apparent life-threatening event (ALTE) describes an acute, unexpected change in an infant’s breathing, appearance, or behavior that is frightening to the parent or caretaker. It is not a specific diagnosis, but rather a “chief complaint” that brings an infant to medical attention. The term ALTE and its definition were established at a consensus conference in 1986. ALTE replaced misleading terms, such as "near-miss SIDS" or "aborted crib deaths", which incorrectly implied a direct association between these symptoms and SIDS .
Infants with ALTE represent a heterogeneous group of patients of varying ages with diverse pathophysiology. The clinical challenge is to identify the infants with medically significant ALTE, and diagnose any underlying disease when possible, while avoiding unnecessary testing for the many infants with medically insignificant ALTE. As a result, appropriate evaluation and management should be individualized. This topic review outlines the primary diagnostic considerations, and a stepwise plan for evaluating infants presenting with this chief complaint.
An apparent life-threatening event (ALTE) is not a specific diagnosis but a description of an acute, unexpected episode that is frightening to the caretaker and that includes one or more of the following features :
●Apnea – usually no respiratory effort (central) or sometimes effort with difficulty (obstructive)
●Color change – usually cyanotic or pallid but occasionally erythematous or plethoric
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- ALTE does not imply SIDS risk
- Gastroesophageal reflux
- Respiratory tract infection
- Seizure or CNS disorder
- Child abuse
- DIAGNOSTIC EVALUATION
- Warning signs
- Initial evaluation
- Additional evaluation
- General recommendations
- Home monitoring
- Risk factors for recurrence
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS