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Etiology and Outcome of Severe Apparent Life-Threatening Events in Infants

Radovanovic, Tanja, MD*; Spasojevic, Slobodan, MD, PhD*†; Stojanovic, Vesna, MD, PhD*†; Doronjski, Aleksandra, MD, PhD*†

doi: 10.1097/PEC.0000000000000891
Original Articles

Introduction An apparent life-threatening event (ALTE) is defined as “an episode that is frightening to the observer and is characterized by some combination of apnea, color change, marked change of muscle tone, choking, or gagging.”

Objective The aims of this study were to determine etiology and outcome of severe ALTE (requiring resuscitation measures) and to review diagnostic approaches in infants hospitalized after such an episode of ALTE.

Methods Retrospective analysis included patients hospitalized at the Intensive Care Unit, Institute of Child and Youth Healthcare of Vojvodina, after an episode of severe ALTE over a 4-year period.

Results The study included 23 infants, 18 male (78.3%), and 5 female (21.7%). The average age at presentation was 78 days (1 day to 11 months). In 8 infants (34.7%), ALTE resulted in death. The most frequent conditions after diagnostic evaluation were lower respiratory tract infections (39.1%), intracranial and extracranial hemorrhages (13.0%), and central nervous system infections (8.6%). The cause remained unknown in 8.7% of cases. Initial investigations included complete blood cell count, C-reactive protein or procalcitonin, blood gasses, lactate, electrolytes, glucose, blood culture, urinalysis, and chest x-ray.

Conclusions Apparent life-threatening event represents a diverse disorder. Lower respiratory tract infections and neurological disorders were the most common established etiology. Prematurity and congenital heart diseases stood out as important risk factors. Diagnostic evaluation varied according to suspected cause and trigger factors.

From the *Institute of Child and Youth Healthcare of Vojvodina; and

Medical Faculty, University of Novi Sad, Novi Sad, Serbia.

Disclosure: The authors declare no conflict of interest.

Reprints: Slobodan Spasojevic, MD, PhD, Institute of Child and Youth Healthcare of Vojvodina, Hajduk Veljkova 10, 21000 Novi Sad, Serbia (e-mail:

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