Apparent Life Threatening Event
ALTE included explained and unexplained
Brief resolved unexplained event (BRUE)
Low-risk BRUE
●Age >60 days
●Gestational age ≥32 weeks and postconceptional age ≥45 weeks
●Single BRUE only (no previous and no cluster)
●Duration of BRUE <1 minute
●No CPR by a trained medical provider
●No concerning Hx
●No concerning Ex
Ix
Full blood count and differential
Urea & electrolytes, blood glucose,
Nasopharyngeal aspirate for viruses & pertussis.
ECG (measure QT interval)
Other?
NAI
Metabolic: lactate, ammonia, acylcarnitine profile
EEG
CT head
Holter monitoring
Urine toxicology / Metabolic screen
ALTE causes
Respiratory (20%): RSV (apnoea) Pertussis
GOR
CNS (10%): Sz
Rx
Observation for oximetry monitoring
(98% of subsequent significances events occur within 24 hours of ED presentation)
Brief resolved unexplained event (BRUE)
- Cyanosis or pallor
- Absent, decreased, or irregular breathing
- Marked change in tone (hyper- or hypotonia)
- Altered level of responsiveness
Low-risk BRUE
●Age >60 days
●Gestational age ≥32 weeks and postconceptional age ≥45 weeks
●Single BRUE only (no previous and no cluster)
●Duration of BRUE <1 minute
●No CPR by a trained medical provider
●No concerning Hx
●No concerning Ex
Ix
Full blood count and differential
Urea & electrolytes, blood glucose,
Nasopharyngeal aspirate for viruses & pertussis.
ECG (measure QT interval)
Other?
NAI
Metabolic: lactate, ammonia, acylcarnitine profile
EEG
CT head
Holter monitoring
Urine toxicology / Metabolic screen
ALTE causes
Respiratory (20%): RSV (apnoea) Pertussis
GOR
CNS (10%): Sz
Rx
Observation for oximetry monitoring
(98% of subsequent significances events occur within 24 hours of ED presentation)