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Abusive head injury as a cause of apparent life-threatening events in infancy

Robin L Altman1, Donald A Brand, Scott Forman

  • 1Department of Pediatrics, Westchester Medical Center, Valhalla, USA. robin_altman@nymc.edu

Archives of Pediatrics & Adolescent Medicine
|October 15, 2003
PubMed

Insights

Abusive head injury is a frequent cause of apparent life-threatening events (ALTEs) in infants, necessitating its consideration in diagnosis. Early ophthalmologic evaluation and cranial imaging are recommended for infants with ALTEs.

Area of Science:

  • Pediatrics
  • Neonatology
  • Child Abuse

Background:

  • An apparent life-threatening event (ALTE) is characterized by infant breathing abnormalities, color changes, or altered muscle tone/mental status.
  • Abusive head injuries were identified in infants admitted for ALTE evaluation.

Purpose of the Study:

  • To systematically investigate the diverse causes of ALTEs in infants.
  • To determine the relative frequencies of identified ALTE causes.

Main Methods:

  • A prospective consecutive case series design was employed.
  • 243 infants under 12 months with ALTEs were evaluated over 32 months at a tertiary care center.

Main Results:

  • Thirty-five distinct causes of ALTEs were identified.
  • Abusive head injuries accounted for 2.5% of cases (1 admission every 5 months).
  • Two of three infant deaths were attributed to abusive head injuries.

Conclusions:

  • ALTEs stem from a broad range of medical conditions.
  • Abusive head injury is a significant and frequent cause of ALTEs, requiring inclusion in differential diagnoses.
  • Ophthalmologic evaluation and cranial imaging are crucial early diagnostic steps for ALTEs when the cause is not immediately apparent.
Abstract

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