Apparent Life-Threatening Event

Question 1

What is an apparent life-threatening event (ALTE)?

Answer 1

Where there is sudden, brief, and often frightening changes in the condition of an infant who was previously well and appear well immediately after

Question 2

How may ALTE present?

Answer 2

• Cyanosis or pallor
• Absent, decreased or irregular breathing
• Change in tone
• Altered level of responsiveness

Question 3

What additional features make a likely diagnosis of ALTE?

Answer 3

No concerning features on detailed history (including social history) and physical examination

Question 4

What investigations are typically performed?

Answer 4

• ECG
• Nasal swabs for pertussis
• Monitoring of pulse oximetry

Question 5

What are the differntials for ALTE?

Answer 5

• GORD
• Pertussis
• LRTI
• Seizure
• UTI
• Factitious illness including FII
• Cardiac arrhythmia e,g, long QT syndrome or SVT

Question 6

What is required in children with ALTE?

Answer 6

A period of baseline obs monitoring

Question 7

What will caregivers need?

Answer 7

An explanation of the condition and BLS training

Question 8

Should follow-ups be arranged?

Answer 8

Yes

Question 9

What should be done if the features are not characteristic of ALTE?

Answer 9

Further assessment and investigation

Question 10

What may cause suspicion of an underlying disorder?

Answer 10

• Age <60 days
• Gestation at birth <32 weeks
• Duration >1 min
• Repeat event
• CPR given by trained medical provider
• Concerning features of history
• Abnormalities on physical examination

Question 11

What features of a history may make you think ALTE has an underlying cause?

Answer 11

• FH of cardiac death
• Child protection concerns
• Cough or breathing suggestive of RTI
• Vomiting suggestive of GORD

Question 12

What features of physical examination may make you think ALTE has an underlying cause?

Answer 12

• Fever

- Respiratory distress