Management of apparent life-threatening events (ALTE)

In contrast to sudden infant deaths, the incidence of apparent life-threatening events (ALTE) has remained rather constant at 0.6–2.5/1000. Identifying the underlying cause of an event is paramount, requires careful history taking and a variety of investigations, summarized in this review. If no preventable cause is found, infants should be placed on a memory monitor, which may help to identify the underlying pathophysiology from analysis of the traces potentially thus recorded. For example, a sudden increase in heart rate despite severe hypoxaemia may suggest an epileptic seizure, while certain inconsistencies between the data recorded and parental reports of the event may hint towards fabricated events. A consistent feature in recorded ALTE that remain unexplained is severe hypoxaemia, mostly without prolonged cessations in breathing movements, suggesting upper airway obstruction or intrapulmonary shunting. If no event occurs in hospital, infants should be discharged on a memory monitor. If no further events occur within 4–6 weeks of the initial event, recurrence risk is very low, and monitoring can be discontinued. A recently discovered entity are neonatal ALTE, which may be related to a potentially asphyxiating environment, e.g. during skin-to-skin contact in the prone position or breast feeding with a mother who is inexperienced in handling and assessing her newborn baby. These situations thus require parental education and careful observation of the newborn by health professionals.