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Consultation with the Specialist

Apparent Life-Threatening Events

Infants who experience apparent life-threatening events (ALTEs) usually generate enormous anxiety among family members and other caretakers and present diagnostic, management, and counseling challenges for the pediatrician. Important considerations for the primary care provider include the following:

1. What is the prognostic significance of the frightening event, particularly in relation to sudden infant death syndrome (SIDS)?

2. Which mechanisms and specific diagnoses should be considered as possible causes of ALTEs?

3. Which infants who present after an ALTE require hospitalization, and what diagnostic evaluation is appropriate?

4. What is the role for home cardiorespiratory monitors, and what is appropriate follow-up for infants who have suffered an ALTE?

Definition

ALTE should be considered a chief complaint rather than a specific diagnosis. In the standard established in 1986 by the National Institutes of Health (NIH) Consensus Development Conference on Infantile Apnea and Home Monitoring, ALTE is defined as "an episode that is frightening to the observer and is characterized by some combination of apnea (central or occasionally obstructive), color change (usually cyanotic or pallid but occasionally erythematous or plethoric), marked change in muscle tone (usually marked limpness), choking, or gagging. In some cases the observer fears that the infant has died." Previously used terminology, such as "aborted crib death" or "nearmiss SIDS," should be abandoned because it implies a possibly misleading close association between this type of event and SIDS.

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