Smaller mandibular size in infants with a history of an apparent life-threatening event
Received 24 August 2005; received in revised form 27 March 2006; accepted 9 June 2006.
Objectives
To examine small mandibular size and preference for a hand-to-chin posture as salient characteristics in infants with a history of an apparent life-threatening event (ALTE).
Study design
This was a prospective case-control study of term infants, from birth to 6 months of age, admitted post-ALTE and matched 1:2 with healthy control infants (age within 2 weeks and weight within 0.5 kg). Infants with confirmed gastroesophageal reflux and congenital anomalies, including severe micrognathia, were excluded.
Results
Infants with a history of an ALTE (n = 25) were matched to 47 healthy controls. Infants with a history of an ALTE had mandibular indices (larger index indicates a smaller mandible) that were 3.8 mm greater on the left side (95% CI: 2.0-5.6, P < .001) and 4.2 mm greater on the right side (95% CI: 2.7-5.6, P < .001) adjusting for length and non-white race. Controlling for matching and length, a 1-mm increase in the average mandibular index increased the odds of an ALTE by 62% (OR = 1.62, 95% CI: 1.22-2.44, P < .001).
Conclusions
Smaller mandibular size was associated with ALTE, suggesting airway obstruction as a potential cause of ALTE. The association of this characteristic with ALTE also offers the potential for prospective quantification of ALTE risk.
Surgical Nursing, Critical Care and Cardiovascular Nursing, and Oral and Maxillofacial Surgery, Children’s Hospital Boston; and the Division of Pediatric Clinical Research, the Department of Pediatrics, the University of Miami Miller School of Medicine, Florida.
Reprint requests: Mary Horn; 10S; Children’s Hospital Boston; 300 Longwood Ave; Boston, MA 02115.
Supported by the Center for Nursing, Children’s Hospital, Boston; The Thoracic Foundation.
ABSTRACT