Assessment and management of infants with apparent life-threatening events in the paediatric emergency department.

Objective: To report our experience with a guideline approach for the assessment of apparent life-threatening events (ALTE) at our paediatric emergency department (PED).

Methods: Prospective observational case series study of a guideline approach for infants under the age of 12 months who suffered an ALTE between 1 April 2005 and 31 June 2006.

Results: A total of 66 infants with ALTE were included. Fourteen had perinatal risk factors and 16 previous ALTE. Only 14 presented significant abnormalities at examination at the PED. Eight had recurrent ALTE at the PED. Laboratory investigations were abnormal in 35 infants. A total of 45 infants were admitted. Associated conditions (secondary ALTE) were reported in 24 infants (36%), mostly respiratory infections and gastroesophageal reflux. Laboratory investigations contributed to a related diagnosis in nine cases. Compared with idiopathic group, the secondary ALTE sufferers had more perinatal risk factors, more abnormal examination findings, higher risk of recurrence and more frequent need for intervention in the PED.

Conclusion: Most infants with a first episode of ALTE have normal physical examination. The absence of data suggesting underlying disease, after detailed history and examination, identifies a pool of infants who may be handled conservatively. This group may be monitored as outpatients after keeping them under watch for a short time at the emergency unit, thus avoiding unnecessary admissions. The low yield of laboratory tests in this group suggests that they could be safely omitted in most ALTE and restricted to cases with risk factors and/or whose progress at the observation unit is not satisfactory.