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Clinical Characteristics of an Apparent Life-Threatening Event (ALTE) and the Subsequent Occurrence of Prolonged Apnea or Prolonged Bradycardia

American Sudden Infant Death Syndrome Institute, 6065 Roswell Road, Suite 876, Atlanta, Georgia 30328

Cheryl Richmond, MD

Vandana Ramaswamy, MPH

Aaron Curns, MPH

American Sudden Infant Death Syndrome Institute, Atlanta, GA

The objective of this study was to test the hypothesis that the characteristics of an apparent life-threatening event (ALTE) influence the risk for a subsequent episode of prolonged apnea or bradycardia. Data were obtained from 182 infants referred because of an apparent lifethreatening event who were followed up at home for 2 lunar months on an apnea/bradycardia monitor with recording capability. A prolonged episode was defined as apnea 20 sec long or an episode of bradycardia 10 sec in duration as validated and measured from the event recordings. Seventeen percent of infants had at least one episode of prolonged apnea or prolonged bradycardia. Change in skin color, degree of resuscitative intervention, and behavioral state were not statistically significant factors influencing the risk of a subsequent prolonged episode. Contrary to clinical expectation, a significantly greater percentage of infants subsequently had a prolonged episode whose muscle tone was described as normal during the ALTE (24.0%), when compared with those infants whose ALTE was associated with limpness or increased muscle tone (9.3%). The coexistence of gastroesophageal reflux did not influence the overall results. The observations in this study place in question the clinical approach of relying on the detailed characteristics of an ALTE in determining the need for follow-up studies and/or home monitoring.

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