"Apparently Life-Threatening Events" (ALTEs) - References
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Otolaryngol Head Neck Surg 1997 Jun;116(6 Pt 1):575-9

Otolaryngic manifestations in children presenting with
apparent life-threatening events.

McMurray JS, Holinger LD

Department of Pediatric Otolaryngology and Maxillofacial Surgery,
Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.

Apparent life-threatening event (ALTE) is a term used to characterize an
event of unknown cause after an infant is found limp, cyanotic,
bradycardic, and/or requiring resuscitation. Like sudden infant death
syndrome (SIDS), ALTE is a general term used until a precise diagnosis can
be established. The relationship between ALTE and SIDS has not been
clearly defined, although 7 to 15 percent of children with ALTE die of
SIDS. If children with ALTE are at greater risk for SIDS, morbidity and
mortality may be prevented if the underlying pathology can be identified
and corrected or closely monitored. The otolaryngologist is being
consulted more frequently to evaluate children who have been through an
ALTE to help elucidate any underlying pathology that may have caused the
near-death experience. This retrospective chart review reports the
evaluation of 30 infants with ALTE requiring consultation by the Division
of Pediatric Otolaryngology at the Children's Memorial Hospital in Chicago
during a 3-year period. We reviewed the literature and here compare our
findings with current animal models. Of the 30 children evaluated, 53% had
gastroesophageal reflux, 40% had laryngeal abnormalities, 13% had tracheal
abnormalities, and 10% had pharyngeal abnormalities. Thirteen percent of
the children had nonotolaryngic anomalies identified during evaluation.
Surgical intervention was required in 10 patients and medical treatment
was used in 18. When evaluating a child with ALTE, a complete history and
physical examination, evaluation for gastroesophageal reflux, assessment
for upper airway obstruction by radiographs and endoscopy, and a
multidisciplinary approach are recommended.


Acta Paediatr Hung 1990;30(3-4):435-47

Factors involved in the pathogenesis of unexpected near
miss events of infants (ALTE).

Kurz R, Kenner T, Reiterer F, Schenkeli R, Haidmayer R, Stockler S,
Paschke E

Department of Pediatrics, University of Graz, Austraia.

Near miss events or apparent life threatening events (ALTE) are considered
preliminary stages of sudden infant death syndrome (SIDS). The current
definition of near miss SIDS postulates that such an event happens
unexpectedly and that no life threatening cause of disease can be
detected. However in 32 of 34 observations of ALTE pathological changes
actually could be identified by through investigations: 11 central nervous
diseases, 10 respiratory tract disturbances, 5 metabolic abnormalities, 5
disturbances of the digestive tract and 1 cardiac disease. There were 22
morphologically manifested causes as opposed to 10 functional failures
mainly respiratory control and oesophageal disturbances. Irrespective of
the main diagnosis sleep apnea syndrome (SAS) could be detected in 17 of
28 infants combined with bradycardia in 5 cases, and oesophageal
disturbances in 16 of 17 infants. Four babies later died, two of them
suffered from carnitine deficiency and one from organic acidopathy. It is
our conclusion that numerous, even banal causes of disease are able to
trigger ALTE if there is a coincidence with phases of increased
instability of vital regulatory mechanisms of autonomous centres in
infants.

PMID: 2083104, UI: 91190440