Related Experiment Videos
[Study of risk factors for recurrence in severe life-threatening conditions in infants]
Y Rimet1, A Poujol, M A Cournelle
1Service de pédiatrie, Centre hospitalier général, Aix-en-Provence, France.
Insights
This study found that functional disorders like gastroesophageal reflux (GER) and vagal hyper-reflectivity (VHR) are common causes of apparent life-threatening events in infants. Effective treatments significantly reduced illness recurrence.
Area of Science:
- Pediatric Medicine
- Neonatology
- Clinical Investigations
Context:
- Apparent life-threatening events (ALTEs) in infants present a diagnostic challenge.
- Distinguishing functional disorders from incidental pathologies is crucial for appropriate management.
- A prospective study investigated the causes and treatment outcomes of ALTEs in hospitalized infants.
Purpose:
- To identify the underlying causes of apparent life-threatening events (ALTEs) in infants.
- To evaluate the efficacy of specific therapies for gastroesophageal reflux (GER) and vagal hyper-reflectivity (VHR).
- To assess the impact of treatment on the recurrence rate of ALTEs.
Summary:
- 180 infants hospitalized for ALTEs underwent comprehensive investigations, revealing functional disorders (neuro-vegetative immaturity, GER, VHR) as the primary cause in 67.5% of cases.
- Incidental pathologies were identified in 18.5%, with 14% showing normal results.
- Diphemanil and Metoclopramide effectively treated VHR and GER, respectively, leading to a significant reduction in recurrence rates (12% vs. 48%) compared to untreated groups.
Impact:
- This research highlights the importance of investigating functional disorders in infants experiencing ALTEs.
- Effective pharmacological interventions for GER and VHR can significantly improve outcomes and reduce recurrence.
- The findings support targeted therapeutic strategies for managing ALTEs in pediatric populations.
Abstract:
In a prospective study, 180 infants, mean age 2-6 months, hospitalized for apparent life threatening events between October 1985 and September 1988 (for 7,261 infants admitted into the pediatric unit during the same period), were submitted to the following investigations: careful anamnesis, complete clinical examination, systematic paraclinical investigations (standard biological studies, infectious and metabolic tests, investigations for gastro esophageal reflux (GER) and vagal hyper-reflectivity (VHR), polysomnography) or adapted to the clinical situation (toxic tests, brain computed scan, laryngoscopy, etc). Pathologies were mainly functional with neuro-vegetative immaturity (67.5%): gastro esophageal reflux (49%), vagal hyper-reflectivity (8.5%) or both (10%). An incidental pathological factor (breath holding spell, convulsion, intoxication, infection) was found in 18.5% of the infants, and 14% had normal results. Diphemanil 10 mg/kg/24h corrected the VHR and Metoclopramide 1 mg/kg/24h controlled 52% of the GER. The recurrence rate of illness in the GER and VHR groups was statistically lower with efficient therapy (12% vs 48%); no recurrence occurred in other groups.