Apparent life-threatening events and sudden infant death on a monitor

This review summarises recent data on mechanisms for apparent life-threatening events (ALTE) and sudden infant death (SID) which show that (i). recordings obtained during ALTE allow the detection of previously unrecognised but preventable mechanisms in a significant proportion of infants and should thus be performed routinely in infants with such a history, (ii). in recordings obtained during SID and idiopathic ALTE, prolonged apnoea was found in only a minority, while severe hypoxaemia appeared to the common mechanism, (iii). it remains yet unclear by which mechanism this hypoxaemia develops, with upper and/or lower airway obstruction, rebreathing of expired air and intrapulmonary shunting being potential candidates, (iv). there is evidence that arousal fails during SID, which could be related to known risk factors such as tobacco smoke exposure, whereas (v). gasping occurred during the majority of SID cases where respiratory patterns have been analysed, but it remains unclear why gasping remains ineffective in resuscitating the infant from hypoxaemia.