ALTE

Apparent Life-Threatening Event

NIH Definition:

An episode that is frightening to the observer and that is characterized by some combination of apnea (central or occasionally obstructive), color change (usually cyanotic or pallid but occasionally erythematous or plethoric), a marked change in muscle tone (usually marked limpness), choking, or gagging.

Apnea = cessation of breathing >20 seconds.

Etiology of ALTE:

Gastrointestinal (33%)

Gastroesophageal reflux

Gastroenteritis

Esophageal dysfunction

Colic

Surgical abdomen

Dysphagia

Neurologic (15%)

Seizure

Central apnea/hypoventilation syndromes (apnea of prematurity, Ondine’s curse)

Head injury (intraventricular hemorrhage, subarachnoid hemorrhage)

Meningitis/encephalitis

Hydrocephalus

Brain Tumor

Neuromuscular disorders

Vasovagal reaction

Congenital malformation of the brainstem

Respiratory (11%)

Respiratory syncytial virus

Pertussis

Aspiration pneumonia

Other lower or upper respiratory tract infection

Reactive airway disease

Foreign body

Otolaryngologic (4%)

Laryngomalacia

Subglottal and/or laryngeal stenosis

Obstructive sleep apnea

Cardiovascular (1%)

Congenital heart disease

Cardiomyopathy

Cardiac arrhythmia/prolonged QTc

Myocarditis

Metabolic/endocrine

Electrolyte disturbance

Hypoglycemia

Inborn error of metabolism

Other infections

Sepsis

Urinary tract infections

Child maltreatment syndrome

Shaken baby syndrome

Intentional suffocation

Munchausen-by-proxy syndrome

Other

Physiologic event (periodic breathing, acrocyanosis)

Breath-holding spell

Choking

Drug or toxin reaction

Unintentional smothering

Anemia

Hypothermia

Idiopathic/apnea of infancy (23%)