What is ALTE?

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Apparent life threatening events (ALTE) are a major headache for both parents and emergency rooms. Infants with these events are defined as having an episode that is frightening to the observer and characterized by some combination of apnea, color change, change in muscle tone, and choking or gagging that requires vigorous stimulation. This is a rather global and imprecise definition to use diagnostically, based on caretaker history. The concern has been that ALTE is an aborted SIDS event. The consistent result of an emergency room visit for ALTE is a complex and expensive evaluation that results in no clear answer as to what caused the ALTE in most cases. The CHIME study prospectively monitored term infants, siblings of SIDS, and preterm infants to learn about what kind of cardiorespiratory events were occurring. The study also enrolled 153 ALTE cases. Esani et al report that infants with ALTE differ from the well-established epidemiology of SIDS. The ALTE infants were younger, less frequently low birth weight or growth restricted, and had fewer teenage mothers. While not clearly separating the populations of ALTE and SIDS patients, the populations do have differences suggesting different etiologies. Only one infant presenting with ALTE died of SIDS. We still do not know what causes ALTE.