Abstract â–¡ 2

The term 'apparent life-threatening event' describes a clinical presentation for which a cause is found in about 50% of cases. Recurrence rates vary, but single and mild episodes may be managed by a period of observation in hospital, with clinical monitoring of SpO2. Recurrent events, or those that are severe (ie have received cardiopulmonary resuscitation) require observation and further investigation. Hypoxaemic episodes as a result of a respiratory disturbance are one of the commonest causes of such episodes, occurring with respiratory infections such as RSV and pertussis, and with anaemia. Epileptic seizures can produce profound desaturation, despite normal inter-ictal EEG's. Gastro-oesophageal reflux can contribute to either colour changes or hypoxaemic episodes. Metabolic disorders and intracranial haemorrhage are less common causes of ALTE. Recurrent events that begin in the presence of one person, have blood found at the nose or mouth, or occur in a sibling of a SIDS victim, may indicate abuse. Further psychosocial assessment may indicate factitious illness or personality disorder in a parent, which supports abuse as the mechanism.

Continuous + physiological recordings of SpO2, pulse waveforms and breathing movements [ECG, transcutaneous / end-tidal carbon dioxide, video, EEG, oesophageal pH] help determine the presence and severity of hypoxaemia, hypoventilation, and associated pathophysiology. Frequent events can be recorded in hospital and may slow, for example, whether epileptic seizure or gastro-oesophageal reflux occur and are temporally related to hypoxaemia. Less frequent events may be diagnosed by home recordings with event capture. If fictitious or induced events are likely, collaboration with other agencies responsible for child protection is essential, with consideration given to use of covert video surveillance to capture subsequent induced events.

Subsequent management depends on whether a cause is found, but home onitoring with the facility to monitor compliance and capture further events, is indicated for severe or recurrent events. Such monitoring should include oxygenation.