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- Linda Y. Fu, MD, MSc*
- Rachel Y. Moon, MD†
- *Assistant Professor of Pediatrics, Goldberg Center for Community Pediatric Health, Children's National Medical Center, Washington, DC
- †Director, Academic Development, Goldberg Center for Community Pediatric Health, Children's National Medical Center, Washington, DC
Objectives
After completing this article, readers should be able to:
Recognize a child who has an apparent life-threatening event (ALTE).
Know the differential diagnosis of ALTE.
Discuss the appropriate management of ALTE.
Describe the role of home monitoring in the care of children who have ALTE.
List the limitations of home monitoring in following children who have ALTE.
Characterize the psychosocial issues surrounding the use of home monitors.
Case
A previously healthy 1-month-old boy who was born at term is brought to the emergency department by ambulance. His mother reports that he stopped breathing for 20 seconds and appeared limp and blue around his lips. Once she picked him up, he began to cry and breathe normally. On physical examination, the baby is well-perfused and in no apparent distress. The infant is admitted for observation and evaluation for an apparent life-threatening event (ALTE). The evaluation includes a complete blood count, urine culture, computed tomography scan of the head, cardiorespiratory monitoring, and pH probe. The pH probe results demonstrate significant gastroesophageal reflux; other findings are unremarkable. The child has no additional episodes after 48 hours in the hospital. After his mother is given information for basic life support courses and educated on sudden infant death syndrome (SIDS) prevention, the child is discharged on antireflux medications. He has no more concerning episodes.
Definitions
ALTE refers to a constellation of unexpected physiologic events in an infant that is witnessed by and distressing to a caregiver. In 1986, an expert panel sponsored by the National Institutes of Health developed the now widely accepted definition of ALTE as “an episode that is frightening to the observer and that 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 …
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