Surveillance study of apparent life-threatening events (ALTE) in the Netherlands

Semmekrot, B.A.; Sleuwen, B.E. van; Engelberts, A.C.; Joosten, Koen; Mulder, Jaap C.; Liem, Kian D.; Pereira, Rob Rodrigues; Bijlmer, R. P. G. M.; L’Hoir, M.P.

doi:10.1007/s00431-009-1012-2

Cited by 49 publications

(54 citation statements)

References 21 publications

(63 reference statements)

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“…The HDR putative codes we selected were mainly suggested by the paediatricians in the ALTE unit who were involved in the diagnostic ALTE Italian guidelines document (5) and had been using those codes for years. The incidence estimate from the HDR database was in accordance with the wider incidence range of 0.5-10.0 per 1000 live births reported by population surveys based on hospital records (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) and also by the 2.46 per 1000 live births reported by a study in the Tyrol area of Italy (11), which used the same administrative database as our study and similar putative morbidity codes for 1993-2001. The 37% of idiopathic ALTE HDR records we found were also similar to the 45% found in the Tyrol study (11).…”

Section: Discussionsupporting

confidence: 89%

Incidence of apparent life‐threatening events and post‐neonatal risk factors

et al. 2016

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Aim: Even though a standard clinical definition for an apparent life-threatening event (ALTE) was established more than two decades ago, the specific International Classification of Disease (ICD) code was firstly included only in 2012. This study estimated the incidence of ALTEs in Northern Italy, together with features and risk factors. Methods:We used the Lombardy Region Hospital Discharge Records (HDR) database to estimate the cumulative incidence for ALTE during 2002-2006 and drew up a risk profile by comparing cases with and without ALTE who were followed in infancy.Results: There were 246 infants registered in the HDR with ALTE putative diagnostic codes, suggesting a cumulative incidence of 4.1 per 1000 live births in the study area. Of the 148 cases with clinical co-morbidities, 31% had gastroesophageal reflux and 7% had acute respiratory infections. We analysed follow-up data from 15 ALTE cases and 1619 healthy infants and found that the significant risk factors were gastroesophageal reflux and a family history of sudden death. Conclusion:We established the regional incidence of ALTE and found risk factors in infants considered healthy in the first week of life and without pathological perinatal conditions. The systematic use of the specific ALTE ICD code (R68.13, ICD-10-CM) and common knowledge about ALTE diagnostic guidelines are clearly needed.

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Section: Discussionsupporting

confidence: 89%

Incidence of apparent life‐threatening events and post‐neonatal risk factors

et al. 2016

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“…11,12 They recorded each study's relevance to the clinical question, research design, setting, time period covered, sample size, patient eligibility criteria, data source, variables collected, key results, study e6 in the updated (n = 18) and original (n = 37) systematic review (Supplemental Table 7). 6,7,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] The resulting systematic review was used to develop the guideline recommendations by following the policy statement from the AAP Steering Committee on Quality Improvement and Management, "Classifying Recommendations for Clinical Practice Guidelines." 29 Decisions and the strength of recommendations were based on a systematic grading of the quality of evidence from the updated literature review by 2 independent reviewers and incorporation of the previous systematic review.…”

Section: Patient Factors That Determine a Lower Riskmentioning

confidence: 99%

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Tieder¹,

Bonkowsky²,

Etzel³

et al. 2016

Pediatrics

142

154

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This is the fi rst clinical practice guideline from the American Academy of Pediatrics that specifi cally applies to patients who have experienced an apparent life-threatening event (ALTE). This clinical practice guideline has 3 objectives. First, it recommends the replacement of the term ALTE with a new term, brief resolved unexplained event (BRUE). Second, it provides an approach to patient evaluation that is based on the risk that the infant will have a repeat event or has a serious underlying disorder. Finally, it provides management recommendations, or key action statements, for lower-risk infants. The term BRUE is defi ned as an event occurring in an infant younger than 1 year when the observer reports a sudden, brief, and now resolved episode of ≥1 of the following: (1) cyanosis or pallor; (2) absent, decreased, or irregular breathing; (3) marked change in tone (hyper-or hypotonia); and (4) altered level of responsiveness. A BRUE is diagnosed only when there is no explanation for a qualifying event after conducting an appropriate history and physical examination. By using this defi nition and framework, infants younger than 1 year who present with a BRUE are categorized either as (1) a lower-risk patient on the basis of history and physical examination for whom evidence-based recommendations for evaluation and management are offered or (2) a higher-risk patient whose history and physical examination suggest the need for further investigation and treatment but for whom recommendations are not offered. This clinical practice guideline is intended to foster a patient-and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient outcomes, support implementation, and provide direction for future research. Each key action statement indicates a level of evidence, the benefi t-harm relationship, and the strength of recommendation.

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“…In a national surveillance survey of all secondary and tertiary care facilities in the Netherlands in 2002, the percentage of premature infants who experienced an ALTE (29.5%) was over twice the percentage in the general population (13%). (2) With an awareness of the role of central respiratory control immaturity in ALTE, the issue of age-based risk more logically focuses on an infant's postconceptual rather than postnatal age. Lack of identification of infants' postconceptional age in earlier studies may explain apparent discrepancies between earlier and more recent studies.…”

Section: What We Have Learned Since Thenmentioning

confidence: 99%

Apparent Life-Threatening Events: An Update

Fu¹,

Moon²

2012

Pediatrics in Review

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Based on strong research evidence, the most common causes of apparent life-threatening events (ALTEs) are gastroesophageal reflux, lower respiratory tract infection, and seizure. • The minimum initial diagnostic panel for ALTE should include complete blood cell (CBC) count with differential; blood levels of C-reactive protein,glucose, sodium, potassium, urea, calcium,magnesium, ammonia, lactate, and pyruvate; arterial blood gas determination, urinalysis, and toxicology screen; electrocardiography; and assessments for Bordetella pertussis and respiratory syncytial virus in season. • Other testing should be done based on the infant’s clinical presentation and clinician’s degree of suspicion.• Most infants should be hospitalized for cardiorespiratory monitoring for 23 hours after an ALTE. • There is strong evidence that newborns are at higher risk of ALTE and sudden infant death syndrome (SIDS)within the first 24 hours after birth and therefore should be frequently monitored as much as possible while room sharing with their mothers. • Evidence suggests that maternal smoking may place an infant for higher risk of SIDS after an ALTE.

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Surveillance study of apparent life-threatening events (ALTE) in the Netherlands

Cited by 49 publications

References 21 publications

Incidence of apparent life‐threatening events and post‐neonatal risk factors

Incidence of apparent life‐threatening events and post‐neonatal risk factors

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Apparent Life-Threatening Events: An Update

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