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.
Suggested reading
Samuels MP, Poets CF, Noyes JP, Hartmann H, Hewertson J, Southall DP . Diagnosis and management after life-threatening events in infants and young children who received cardiopulmonary resuscitation. BMJ 1993; 306: 489–92.
Poets CF, Samuels MP, Noyes JP, Hewertson J, Hartmann H, Holder A, Southall DP . Home event recordings of oxygenation, breathing movements, and heart rate and rhythm in infants with recurrent life-threatening events. Pediatrics 1993; 123: 693–701.
Poets CF, Samuels MP, Southall DP . Potential role of intrapulmonary shunting in the genesis of hypoxemic episodes in infants and young children. Pediatrics 1992; 90: 385–391.
Samuels MP, Poets CF, Southall DP . Abnormal hypoxemia after life-threatening events in infants born before term. J Pediatr 1994; 125: 441–446.
Hewertson J, Poets CF, Samuels MP, Boyd SG, Neville BGR, Southall DP . Epileptic seizure-induced hypoxaemia in infants with apparent life-threatening events. Pediatrics 1994; 94: 148–156.
Southall DP, Plunkett MCB, Banks MW, Falcov AF, Samuels MP . Covert video recordings of life-threatening child abuse: lessons for child protection. Pediatrics 1997; 100: 735–760.
Poets CF, Samuels MP, Noyes JP, Jones KA, Southall DP . Home monitoring of transcutaneous oxygen tension in the early detection of hypoxaemia in infants and young children. Arch Dis Child 1991; 66: 676–682.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Samuels, M. The Management of Alte. Pediatr Res 45, 1 (1999). https://doi.org/10.1203/00006450-199905020-00002
Issue Date:
DOI: https://doi.org/10.1203/00006450-199905020-00002