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Smaller mandibular size in infants with a history of an apparent life-threatening event

Mary H Horn1, Daniel D Kinnamon, Nalton Ferraro

  • 1Surgical Nursing, Children's Hospital Boston, Boston, MA 02115, USA. mary.horn@childrens.harvard.edu

The Journal of Pediatrics
|October 3, 2006
PubMed

Insights

Infants experiencing an apparent life-threatening event (ALTE) often have smaller lower jaw size. This finding suggests airway obstruction may cause ALTE and could help predict risk.

Area of Science:

  • Pediatric Medicine
  • Neonatology
  • Otolaryngology

Background:

  • Apparent life-threatening events (ALTE) in infants are concerning clinical events.
  • The etiology of ALTE is often multifactorial, with airway obstruction being a suspected contributor.
  • Infantile mandibular hypoplasia is a potential risk factor for airway compromise.

Purpose of the Study:

  • To investigate the association between reduced mandibular size and ALTE in infants.
  • To explore the hand-to-chin posture as a potential characteristic in infants with ALTE.
  • To determine if mandibular size can serve as a predictive marker for ALTE risk.

Main Methods:

  • A prospective case-control study involving term infants aged 0-6 months.
  • Infants with a history of ALTE were matched 1:2 with healthy controls based on age and weight.
  • Exclusion criteria included confirmed gastroesophageal reflux and congenital anomalies like severe micrognathia.

Main Results:

  • Infants with ALTE (n=25) exhibited significantly smaller mandibular size compared to matched controls (n=47).
  • Mandibular indices were greater by 3.8 mm (left) and 4.2 mm (right) in the ALTE group, adjusting for covariates.
  • A 1-mm increase in average mandibular index correlated with a 62% increased odds of ALTE (OR=1.62).

Conclusions:

  • Smaller mandibular size is significantly associated with apparent life-threatening events in infants.
  • This association suggests that airway obstruction due to mandibular hypoplasia may be a contributing factor to ALTE.
  • Mandibular size assessment may offer a method for prospective risk quantification of ALTE.
Abstract

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