Apparent Life-Threatening Events in the Young Infant and Neonate

An apparent life-threatening event (ALTE) is characterized by some combination of apnea, change in color and tone, choking, or gagging. It is frightening to the observer and presents a difficult clinical challenge. There is no standard evaluation for an infant with an ALTE, with history and physical examination being the keys to directing the diagnostic workup. In young infants, prematurity plays a significant role in the diagnostic possibilities that include gastrointestinal, neurologic, and infectious conditions. The goal is to identify a treatable cause that will define the expected natural history. Evidence is lacking regarding the true risk of subsequent events and death vs the perceived risk of death, which is complicated by the heterogeneity of the group of infants with ALTE. The presentation, differential diagnosis, plan for evaluation, and management of the young infant with ALTE will be reviewed, as well as the relationship of ALTE and sudden infant death syndrome and the literature regarding ALTE in the newborn infant.