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Management of apparent life-threatening events in infants: a systematic review

Joel S Tieder1, Robin L Altman, Joshua L Bonkowsky

  • 1Department of Pediatrics, Division of Hospital Medicine, Seattle Children's Hospital and the University of Washington, Seattle, WA 98105, USA. joel.tieder@seattlechildrens.org

The Journal of Pediatrics
|February 19, 2013
PubMed

Insights

Certain historical and physical exam findings can identify infants at risk after an apparent life-threatening event (ALTE). Tailored testing may help, but more research is needed for precise risk assessment.

Area of Science:

  • Pediatric Emergency Medicine
  • Clinical Risk Stratification
  • Child Health Outcomes

Background:

  • Apparent life-threatening events (ALTEs) present diagnostic challenges in well-appearing infants.
  • Identifying infants at risk for adverse outcomes or serious diagnoses is crucial for appropriate management.
  • Current guidelines lack definitive criteria for testing and hospitalization after ALTE.

Purpose of the Study:

  • To identify historical and physical examination features indicating risk in infants post-ALTE.
  • To determine appropriate diagnostic testing for infants presenting with ALTE.
  • To evaluate the yield of routine screening tests in low-risk infants.

Main Methods:

  • Systematic review of clinical studies published from 1970-2011.
  • Included 37 observational studies (18 prospective, 19 retrospective).
  • Excluded case reports; used keywords for ALTE.

Main Results:

  • No studies provided sufficient evidence to fully address clinical questions.
  • Risk factors identified: prematurity, multiple ALTEs, suspected child maltreatment.
  • Routine screening tests (reflux, meningitis, bacteremia, seizures) have low yield in infants without specific risk factors or suggestive findings.

Conclusions:

  • Historical and physical exam findings can help identify at-risk infants post-ALTE.
  • Tailored testing based on identified risks may be beneficial.
  • Further research and a precise ALTE definition are warranted to ascertain true risk.
Abstract

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