goodbye ALTE, hello BRUEDani Hall

Consultant in Children’s Emergency Medicine

George

Apparent Life Threatening Event

1%

95%

1%

ALTE

GIidio-

pathic

resp

neuro

ENTCVS

meta-bolic

Infec-tion

NAI

ALTE vs SUDI (Sudden unexpected death in infancy)

NAI as a cause of ALTEs(non-accidental injury)

So, should we extensively investigate?

goodbye ALTE hello BRUE

>60 days

≥32 weeks

Only 1

No CPR

Nil concerning

SHOULD

- Share decisions

- CPR training

SHOULD NOT

- Do bloods, LPs, CXR, echo, EEG

- Empirically treat reflux

MAY

- Pertussis swab / ECG

- Brief monitoring

NEED NOT

- Viral swabs, urine, glucose, gas

- Admit for observation

Low risk BRUE

So what should we do with George?

references1. National Institutes of Health Consensus Development Conference on Infantile Apnea and Home

Monitoring, Sept 29 to Oct 1, 1986. Pediatrics. 1987;79(2):292-299. (Consensus document)

2. Kiechl-Kohlendorfer U, Hof D, Pupp Peglow U, et al. Epidemiology of apparent life threatening events. Arch Dis Child. 2005;90:297-300.

3. Sahewalla R, Gupta D, Kamat D. Apparent Life-Threatening Events: An Overview. Clin Pediatr.2015 doi: 10.1177/0009922815591890

4. Smith MB, Talbot AC. Management of apparent life-threatening events. Paediatr.Child Health. 2009;19(3):114-120.

5. Clinical Practice Guidelines: Apparent Life Threatening Event. Royal Children’s Hospital, Melbourne, Australia.

6. Sarohia M, Platt S. Apparent Life-Threatening Events in Children: Practical Evaluation and Management. Pediatr Emerg Med Prac. 2014;11(4):1-15.

7. McGovern MC, Smith MB. Causes of apparent life threatening events in infants: a systematic review. Arch Dis Child. 2004;89:1043-1048.

8. Tieder JS, Altman RL, Bonkowsky JL, et al. Management of Apparent Life-Threatening Events in Infants: A Systematic Review. J Pediatr. 2013;163(1):94-99

9. Tieder JS, Bronkowsky KL, Etzel RA et al. Brief Resolved Unexplained Events (formerly Apparent Life Threatening Events) and evaluation of lower risk infants. Pediatrics. 2016; 137)5):e20160590