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Risk factors for extreme events in infants hospitalized for apparent life-threatening events
Hussein A Al-Kindy1, Jean-François Gélinas, George Hatzakis
1Respiratory Medicine Division, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Canada.
Insights
Infants with apparent life-threatening events (ALTE) who are born prematurely or have upper respiratory tract infections (URTI) are more likely to experience extreme cardiorespiratory events. Pulse oximeter monitoring can help identify these high-risk infants.
Area of Science:
- Pediatrics
- Neonatology
- Cardiorespiratory Medicine
Background:
- Apparent life-threatening events (ALTE) are a concern in infant care.
- Identifying infants at risk for severe cardiorespiratory events is crucial for timely intervention.
Purpose of the Study:
- To investigate if known risk factors for cardiorespiratory illnesses can predict extreme events in infants admitted for ALTE.
- To assess the occurrence of extreme events during hospitalization and subsequent home monitoring.
Main Methods:
- Retrospective cohort study of 625 infants admitted for ALTE (1996-2006).
- Defined extreme events as central apnea >30s, bradycardia >10s, or desaturation <80%.
- Analyzed risk factors including prematurity, post-conceptional age, and upper respiratory tract infections (URTI).
Main Results:
- 46 infants (7.4%) experienced extreme cardiorespiratory events, mostly within 24 hours of admission.
- Premature birth (6.3-fold), post-conceptional age <43 weeks (5.2-fold), and URTI symptoms (11.2-fold) significantly increased event likelihood.
- Extreme desaturations, often preceded by central apnea, were most common. Seven infants had events during home monitoring.
Conclusions:
- Extreme cardiorespiratory events are associated with URTI symptoms, prematurity, and younger post-conceptional age (<43 weeks).
- Pulse oximeter monitoring is recommended to identify infants experiencing these severe events.
Objective:
To determine whether known risk factors for cardiorespiratory illnesses will help identify infants who could experience extreme events during an admission for an apparent life-threatening event (ALTE) or later at home.
Study Design:
Retrospective cohort study of all patients admitted for ALTE between 1996 and 2006. Extreme events included central apnea >30 seconds, bradycardia >10 seconds, and desaturation >10 seconds at hemoglobin-oxygen saturation value with pulse oximetry <80%.
Results:
Of the 625 patients included in the study, 46 (7.4%) had extreme cardiorespiratory events recorded, usually within 24 hours of hospital admission. The most frequent diagnosis was upper respiratory tract infection (URTI, 30 infants). These factors increased the likelihood of having extreme events (P < .0001): post-conceptional age <43 weeks (5.2-fold increase), premature birth (6.3-fold), and URTI symptoms (11.2-fold). The most frequent events were extreme desaturations (43/46 infants), preceded by a central apnea. Seven infants had extreme events recorded later during home monitoring (4 with URTI); all 7 infants had sustained extreme events in the hospital.
Conclusion:
Extreme events were identified mostly in association with symptoms of URTIs, in infants born prematurely, and in infants <43 weeks post-conceptional age. Monitoring with a pulse oximeter should identify infants who sustain these events.
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