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Cardiac testing and outcomes in infants after an apparent life-threatening event
Robert Hoki1, Joshua L Bonkowsky, L LuAnn Minich
1Primary Children's Medical Center, Division of Pediatric Cardiology, Department of Pediatrics, University of Utah School of Medicine, 100 N. Mario Capecchi Drive, Salt Lake City, UT 84058, USA. nelangi.pinto@imail.org
Insights
Cardiac disease is rare in infants experiencing an apparent life-threatening event (ALTE). Prematurity is a key predictor, though cardiac testing shows low predictive value for these infants.
Area of Science:
- Pediatric Cardiology
- Neonatal Medicine
- Clinical Outcomes Research
Background:
- Apparent life-threatening events (ALTE) in infants can be concerning for underlying cardiac conditions.
- Determining the diagnostic yield and predictors of cardiac disease in this population is crucial for appropriate management.
Purpose of the Study:
- To ascertain the frequency of cardiac disease in infants hospitalized for an apparent life-threatening event (ALTE).
- To identify clinical predictors associated with cardiac abnormalities in infants presenting with ALTE.
Main Methods:
- A retrospective longitudinal cohort study was conducted.
- Infants hospitalized for ALTE between 1999 and 2003 were analyzed.
- Cardiac testing results and clinical data were reviewed, with follow-up for cardiac diagnoses.
Main Results:
- Of 485 infants, 45% underwent cardiac testing during hospitalization, identifying two cases of significant cardiac disease.
- Over 7.7 years of follow-up, three additional significant cardiac diagnoses were made.
- Significant cardiac disease was associated with prematurity (p=0.002); cardiac testing had a low positive predictive value.
Conclusions:
- Significant cardiac disease was identified in less than 1% of infants with ALTE.
- Prematurity was the sole identified clinical predictor of cardiac disease.
- While electrocardiography (ECG) showed sensitivity, routine cardiac testing requires further evaluation due to low positive predictive value.
Objectives:
We sought to determine the yield of cardiac testing and to identify predictors of cardiac disease in infants with an apparent life-threatening event (ALTE).
Design:
Retrospective longitudinal cohort study.
Setting:
Paediatric hospital providing primary and tertiary care that is part of an integrated healthcare system.
Patients:
Infants hospitalised for an ALTE from 1999 to 2003.
Main Exposures:
Cardiac testing used at time of ALTE and results, and clinical risk factors for cardiac disease.
Outcome Measures:
Short-term (during hospitalisation) and long-term (through November 2009) follow-up for any diagnosis of significant cardiac anatomic or rhythm abnormality.
Results:
Study criteria were met by 485 infants (mean age 1.9, SD±2.2 months; 49% boys). Cardiac testing was performed on 219 (45%) patients during ALTE hospitalisation, identifying two patients with significant cardiac disease (cardiomyopathy, ventricular pre-excitation). During 7.7 years of follow-up, three additional significant cardiac diagnoses (ventricular pre-excitation, frequent ventricular ectopy, moderate aortic stenosis) were identified. All cardiac tests had low positive predictive value (PPV). Significant cardiac disease was associated with prematurity (22% vs 80%, p=0.002), but not age, gender, prior ALTE or rescue breaths.
Conclusions:
This longitudinal study of an ALTE cohort revealed significant cardiac disease in <1% of patients. Prematurity was the only clinical predictor identified. ECG was sensitive for identifying significant cardiac disease, but routine testing warrants further investigation because of the low PPV.
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