Usefulness of airway evaluation in infants initially seen with an apparent life-threatening event

To determine how often the pediatric otolaryngology service is involved in the initial care of infants with an apparent life-threatening event (ALTE), to assess the usefulness of bronchoscopy and laryngoscopy in diagnosing the underlying etiology, and to describe the long-term airway outcomes and whether these patients were seen by the pediatric otolaryngology service over a 5-year follow-up period.

Retrospective observational study.

Tertiary children's hospital affiliated with a university hospital.

Screened were 187 903 patient visits for infants younger than 12 months. A total of 1148 infants with an ALTE were identified, 471 of whom met study inclusion criteria. To identify the study population, these infants were cross-referenced against a database of 5156 patients who underwent airway evaluation by the pediatric otolaryngology service.

Airway evaluation with or without intervention.

Four hundred seventy-one infants with an ALTE met study inclusion criteria, 9 of whom subsequently underwent airway evaluation via bronchoscopy, laryngoscopy, or both. Three were referred during their initial ALTE admission, and 6 were seen later in childhood. Five of 9 patients had normal findings, 3 patients had laryngomalacia (including 2 with laryngeal edema), and 1 patient had adenotonsillar hypertrophy. Interventions consisted of 2 supraglottoplasties and 1 adenotonsillectomy.

Among well-appearing infants hospitalized with an ALTE, 98.1% (462 of 471) did not undergo subsequent airway evaluation, and only 0.6% (3 of 471) ultimately required pediatric otolaryngologic surgical intervention during 5 years after the event. This study shows that otolaryngologists are not frequently consulted for well-appearing infants with an ALTE and that airway abnormalities are rare.