Risk Factors for Extreme Events in Infants Hospitalized for Apparent Life-threatening Events
Received 17 June 2008; received in revised form 23 July 2008; accepted 28 August 2008. published online 28 October 2008.
Refers to article:
ALTEs: Still a Puzzle after All These Years
Robert A. Darnall
The Journal of Pediatrics
March 2009 (Vol. 154, Issue 3, Pages 317-319) Full Text |
Full-Text PDF (84 KB)
Objective
To determine whether known risk factors for cardiorespiratory illnesses will help identify infants who could experience extreme events during an admission for an apparent life-threatening event (ALTE) or later at home.
Study design
Retrospective cohort study of all patients admitted for ALTE between 1996 and 2006. Extreme events included central apnea >30 seconds, bradycardia >10 seconds, and desaturation >10 seconds at hemoglobin-oxygen saturation value with pulse oximetry <80%.
Results
Of the 625 patients included in the study, 46 (7.4%) had extreme cardiorespiratory events recorded, usually within 24 hours of hospital admission. The most frequent diagnosis was upper respiratory tract infection (URTI, 30 infants). These factors increased the likelihood of having extreme events (P < .0001): post-conceptional age <43 weeks (5.2-fold increase), premature birth (6.3-fold), and URTI symptoms (11.2-fold). The most frequent events were extreme desaturations (43/46 infants), preceded by a central apnea. Seven infants had extreme events recorded later during home monitoring (4 with URTI); all 7 infants had sustained extreme events in the hospital.
Conclusion
Extreme events were identified mostly in association with symptoms of URTIs, in infants born prematurely, and in infants <43 weeks post-conceptional age. Monitoring with a pulse oximeter should identify infants who sustain these events.
Respiratory Medicine Division, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Canada
Reprint requests: Aurore Côté, Respiratory Medicine Division, The Montreal Children's Hospital, 2300 Tupper, D-380, Montreal, Canada, H3H 1P3
Supported in part by the Réseau en santé respiratoire (Respiratory Health Network) of the Fonds de la recherché en santé du Québec. The authors declare no conflicts of interest, real or perceived.
Dr Al-Kindy is presently at the Child Health Department, Sultan Qaboos University Hospital, Sultanate of Oman.
ABSTRACT