Apparent life-threatening events in presumed healthy neonates during the first three days of life

To study the historical, clinical and pneumographic correlates of apparent life-threatening events (ALTEs) in a term newborn nursery population during the first 3 days of life in a maternity hospital.

Twenty newborns with ALTEs during the first 3 days of life were studied. Family, antenatal, and intrapartum histories were reviewed. Diagnostic and therapeutic data surrounding the ALTEs were documented. Multichannel recordings performed after the ALTEs occurred were analyzed. Hospital discharge dispositions and postdischarge outcomes were reviewed.

Of approximately 15 000 deliveries during a three-year period, 20 infants had ALTEs. Apnea was the most common presenting symptom, and cyanosis usually accompanied the event. Tactile stimulation and oxygen were the most frequent acute treatments, with airway clearance, intermittent positive pressure ventilation, and cardiac massage less common. Forty percent of the events had potentially identifiable causes, including central nervous system abnormality, airway obstruction, or a persistent fetal cardiovascular shunt. Of the initial nultichannel recordings, 11 had desaturation oor less the 85%, 10 had apneic pauses of greater than 15 seconds, and 4 had bradycardia of less than 80 beats per minute. Eighteen infants were discharged and received home monitors; 4 received medication. ALTEs recurred in 4 infants before discharge and in 1 after discharge. No deaths occurred.

(1) ALTEs do occur in the early newborn period in a low-risk term group; (2) causes are unknown in the majority of cases; (3) multichannel recordings may have abnormalities; and (4) the likelihood of recurrent ALTEs is greater during the first week than during the next 2 months.