Management of Apparent Life-Threatening Events in Infants: A Systematic Review

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• 作者：Joel S. Tieder ; MD ; MPH¹ ; ^{joel.tieder@seattlechildrens.org} ; Robin L. Altman ; MD² ; Joshua L. Bonkowsky ; MD ; PhD³ ; Donald A. Brand ; PhD⁴ ; ⁵ ; Ilene Claudius ; MD⁶ ; Diana J. Cunningham ; MLS ; MPH ; AHIP⁷ ; Craig DeWolfe ; MD ; Med⁸ ; Jack M. Percelay ; MD ; MPH⁹ ; Raymond D. Pitetti ; MD ; MPH¹⁰ ; Michael B.H. Smith ; MB ; FRCPC ; FRCPCH¹¹
• 关键词：ALTE ; Apparent life-threatening event ; ED ; Emergency department ; EEG ; Electroencephalogram ; GER ; Gastroesophageal reflux ; RR ; Relative risk ; SIDS ; Sudden infant death syndrome ; URI ; Upper respiratory tract
• 刊名：The Journal of Pediatrics
• 出版年：2013
• 出版时间：July, 2013
• 年：2013
• 卷：163
• 期：1
• 页码：94-99.e6
• 全文大小：181 K

文摘

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Objective

To determine in patients who are well-appearing and without a clear etiology after an apparent life-threatening event (ALTE): (1) What historical and physical examination features suggest that a child is at risk for a future adverse event and/or serious underlying diagnosis and would, therefore, benefit from testing or hospitalization? and (2) What testing is indicated on presentation and during hospitalization?

Study design

Systematic review of clinical studies, excluding case reports, published from 1970 through 2011 identified using key words for ALTE.

Results

The final analysis was based on 37 studies; 18 prospective observational, 19 retrospective observational. None of the studies provided sufficient evidence to fully address the clinical questions. Risk factors identified from historical and physical examination features included a history of prematurity, multiple ALTEs, and suspected child maltreatment. Routine screening tests for gastroesophageal reflux, meningitis, bacteremia, and seizures are low yield in infants without historical risk factors or suggestive physical examination findings.

Conclusion

Some historical and physical examination features can be used to identify risk in infants who are well-appearing and without a clear etiology at presentation, and testing tailored to these risks may be of value. The true risk of a subsequent event or underlying disorder cannot be ascertained. A more precise definition of an ALTE is needed and further research is warranted.