Hospitalizations due to ALTE

Pereira Rossell Hospital Center 1/12/2010 - 1/12/2011

  • Virginia Kanopa Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Departamento de Pediatría y Especialidades. Profesora Agregada de Pediatría
  • María Noel Cuadro Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Departamento de Pediatría y Especialidades. Profesora Agregada de Pediatría
  • Alejandra de León Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Departamento de Pediatría y Especialidades. Médico Posgrado de Pediatría
  • Lorena De León Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Departamento de Pediatría y Especialidades. Médico Posgrado de Pediatría
  • Ana Milovidov Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Departamento de Pediatría y Especialidades. Médico Residente de Pediatría
  • Gustavo Giachetto Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Departamento de Pediatría y Especialidades. Clínica Pediátrica. Profesor
Keywords: INFANTILE APPARENT LIFE-THREATENING EVENT, HOSPITALIZATION

Abstract

Introduction: ALTE creates anxiety and results in families being worried families, constituting a challenge for health professionals. However, there are no data available in Uruguay to assess how big the problem is.
Objective: To describe prevalence and characteristics infants hospitalized due to ALTE in the Pediatrics Unit at the Pereira Rossell Hospital Center.
Method: Design: descriptive, retrospective study. Period: December 1, 2010 through December 1, 2011. Criteria for inclusion: hospitalized infants younger that one year old, who had a diagnosis of ALTE. Variables: age, sex, risk factors for sudden infant death syndrome, studies and interconsultations, evolution, length of hospitalization and diagnosis on discharge. Source of data: clinical records. Analysis: Epiinfo 2002 version.
Results: Two thousand six hundred and ninety five children younger than 1 year old: 71 (2.6 %) had ALTE. Hospitalization rate: 26.3/1000 (IC95% 20.2-32-3); 52% were boys; 62% < 2 months. Paraclinical studies were requested in 62 out of 71 children with ALTE: in 8/8 with high ALTE, in 46/50 with lower ALTE with risk factors, 8/13 with lower ALTE without risk factors. Diagnosis on discharge was idiopathic ALTE in 36/71 (50.7%) and secondary ALTE in 35/71 (49.3%). Digestive causes were identifies in 21 out of 35 cases, respiratory in 12 out of 35 cases and neurological in 2 out of 35 cases. Average hospital stay was 7 days (1-51 days range). Four children were admitted to the ICU. None of them required mechanic ventilation and none of them died.
Conclusion: Most hospitalizations due to ALTE occur in infants younger than 2 months old at the CHPR, and they consult for changes in color, evidencing risk factors for sudden infant death syndrome. The present study points out there are no uniform criteria to treat these children and diagnostic testing had a low yield.

References

(1) National Institutes of Health Consensus Development. Conference on Infantile Apnea and Home Monitoring, Sept 29 to Oct 1, 1986. Pediatrics 1987; 79(2):292-9.
(2) Kahn A; European Society for the Study and Prevention of Infant Death. Recommended clinical evaluation of infants with an apparent life-threatening event. Consensus document of the European Society for the Study and Prevention of Infant Death, 2003. Eur J Pediatr 2004; 163(2):108-15.
(3) McGovern MC, Smith MB. Causes of apparent life threatening events in infants: a systematic review. Arch Dis Child 2004; 89(11):1043-8.
(4) Edner A, Wennborg M, Alm B, Lagercrantz H. Why do ALTE infants not die in SIDS? Acta Paediatr 2007; 96(2):191-4.
(5) Zenteno D, Quiroz G, Celis M, Tapia J. Causas atribuidas a eventos de aparente amenaza a la vida del lactante. Rev Chil Pediatr 2008; 79(2): 163-71.
(6) López López J, Alonso Morales V. Episodio aparentemente letal (EAL) en el lactante: diagnóstico diferencial e indicaciones de monitorización domiciliaria. En: Asociación Española de Pediatría. Grupo de Trabajo para el Estudio y Prevención de la Muerte Súbita Infantil. Síndrome de la muerte súbita del lactante: libro blanco. 2 ed. Madrid: Ergon, 2003:79-89.
(7) Kahn A, Rocca M. ¿Qué es un evento de aparente amenaza a la vida (ALTE)? Arch Arg Pediatr 2001; 99(1):77-8.
(8) Fajardo Ochoa F, Olivas Peñuñuri M. Eventos de aparente amenaza a la vida (ALTE). Bol Clin Hosp Infant Estado Sonora 2005; 22:40-6.
(9) Asociación Latinoamericana de Pediatría. Comité de estudio y prevención en síndrome de muerte súbita del lactante. Consenso para la reducción del riesgo en el síndrome de muerte súbita del lactante, Arch Pediatr Urug 2003; 74(4):275-7.
(10) Asociación Latinoamericana de Pediatría. Comité de estudio y prevención en síndrome de muerte súbita del lactante. Guía de práctica clínica: episodio de posible amenaza a la vida – ALTE. Montevideo: ALAPE, 2005. Disponible en: http://www.alape.org/docs/documentos/guia_alte1.pdf. Consulta: 10 octubre 2013.
(11) Willinger M, James LS, Catz C. Defining the sudden infant death syndrome (SIDS): deliberations of an expert panel convened by the National Institute of Child Health and Human Development. Pediatr Pathol 1991; 11(5):677-84.
(12) Kanopa V, Gontade C, Rubio I. Episodio de posible amenaza a la vida (ALTE). En: Bello O, Sehabiague G, Prego J, de Leonardis D. Pediatría: urgencias y emergencias. 3 ed. Montevideo: BiblioMédica; 2009: 311-8.
(13) Hospital Zonal Especializado Dr. Noel H. Sbarra. Unidad de Docencia e Investigación. Residencia de Pediatría Comunitaria. ALTE: Acute Life Threatening Episode, Episodio de Posible Amenaza a la Vida. Normas Atención 2011; p.56-61. Disponible en: http://www.hospitalsbarra.com.ar/ folderAcademica/normasatencion/09-ALTE-2011- p56-61.pdf. Consulta: 17 diciembre 2012.
(14) Kiechl-Kohlendorfer U, Hof D, Peglow UP, Traweger-Ravanelli B, Kiechl S. Epidemiology of apparent life threatening events. Arch Dis Child 2005; 90(3):297-300.
(15) Fu LY, Moon RY. Apparent life-threatening events: an update. Pediatr Rev 2012; 33(8):361-8
(16) Borbonet D, Giacometti M, Abdala D, García A. Semiología del recién nacido normal. En: Pérez W, García A. Semiología pediátrica. Montevideo: Oficina del libro, FEFMUR, 2010:259-77.
(17) Martell M, Martínez G. Semiología del crecimiento uterino. En: Pérez W, García A. Semiología pediátrica. Montevideo: Oficina del libro, FEFMUR, 2010:109-23.
(18) Poets A, Urschitz MS, Steinfeldt R, Poets CF. Risk factors for early sudden deaths and severe apparent life-threatening events. Arch Dis Child Fetal Neonatal Ed 2012; 97(6):F395-7.
(19) Kaji AH, Claudius I, Santillanes G, Mittal MK, Hayes K, Lee J, et al. Apparent life-threatening event: multicenter prospective cohort study to develop a clinical decision rule for admission to the hospital. Ann Emerg Med 2013; 61(4):379-387. e4.
(20) Brand DA, Altman RL, Purtill K, Edwards KS. Yield of diagnostic testing in infants who have had an apparent life-threatening event. Pediatrics 2005; 115(4):885-93.
(21) Kant S, Fisher JD, Nelson DG, Khan S. Mortality after discharge in clinically stable infants admitted with a first-time apparent life-threatening event. Am J Emerg Med 2013; 31(4):730-3.
(22) Tieder JS, Altman RL, Bonkowsky JL, Brand DA, Claudius I, Cunningham DJ, et al. Management of apparent life-threatening events in infants: a systematic review. J Pediatr 2013; 163(1):94-9.e1-6.
(23) Sarohia M, Platt S. Apparent life-threatening events in children: practical evaluation and management. Pediatr Emerg Med Pract 2014; 11(4):1-14.
(24) Wenzl TG, Schenke S, Peschgens T, Silny J, Heimann G, Skopnik H. Association of apnea and nonacid gastroesophageal reflux in infants: Investigations with the intraluminal impedance technique. Pediatr Pulmonol 2001; 31(2):144-9.
(25) Arad-Cohen N, Cohen A, Tirosh E. The relationship between gastroesophageal reflux and apnea in infants. J Pediatr 2000; 137(3):321-6.
(26) Doshi A, Bernard-Stover L, Kuelbs C, Castillo E, Stucky E. Apparent life-threatening event admissions and gastroesophageal reflux disease: the value of hospitalization. Pediatr Emerg Care 2012; 28(1):17-21.
Published
2014-12-31
How to Cite
1.
Kanopa V, Cuadro MN, de León A, De León L, Milovidov A, Giachetto G. Hospitalizations due to ALTE. Rev. Méd. Urug. [Internet]. 2014Dec.31 [cited 2024Nov.24];30(4):218-25. Available from: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/229
Issue
Vol 30 No 4 (2014): Revista Médica del Uruguay
Section
Original Articles
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