Malaises du nourrisson Diagnostic et prise en charge

"Apparent life threatening events" (ALTE) in infants refer to a wide variety of events, with different grades of severity. None should be neglected (warning value). Main clinical signs are: paleness or cyanosis, respiratory irregularities, hypotonia, loss of consciousness. The combination of their intensity and duration determines the severity of the ALTE: from mild and brief to deep and prolonged, requiring medical resuscitation. Despite the absence of physical sequelae for the child, the consequent anxiety of the family must find psychological support. An aetiological diagnosis must be obtained immediately (emergency management) or secondarily (prevention of further episodes). A careful interview of the family/attendants is essential. Clinical examination is completed by radiological and laboratory evaluations (usually performed in the hospital) depending on the aetiological hypotheses. Aetiology may seem evident in case of known context or obvious background: acute infection, cyanotic congenital heart disease, child abuse, gastro-oesophageal reflux (GER), vagal hyperreactivity (VHR), associated VHR/HRV. The ALTE may also be the first manifestation of an unrecognized, incipient, or latent disease: left ventricular obstruction, dysrhythmia, neurological acute disorder, hypoglycaemia (metabolic disease). Some ALTE may be initially unexplained: parents should learn resuscitation and accept a follow-up and later re-evaluation. In case of unexplained or recurrent ALTE (despite treatment), home monitoring may be proposed. Specific treatment is adapted to the identified aetiology, with the cooperation of concerned specialists. Despite the success of the supine sleep position in preventing sudden infant death syndrome, a number of other causes of ALTE are still encountered, some of which may lead to death. No ALTE should therefore go neglected, witnesses' reports should be considered and every effort should be made to obtain the aetiological diagnosis that will prevent recurrence.