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Apparent life-threatening events 

Apparent life-threatening events
Apparent life-threatening events

Jeremy Hull

, Julian Forton

, and Anne Thomson

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Subscriber: null; date: 19 June 2019


  • ALTEs are those where:

    • the affected infant has a sudden change in behaviour, characterized by a combination of apnoea, choking, colour change, or change in tone;

    • the parent or carer is very alarmed and may think that the child is dying;

    • the parent or carer usually initiates some form of life support.

  • Most infants will be 2–4 months of age. ALTE is commoner in babies born prematurely.

  • The term near-miss cot death, which implies a causal link with SIDS, should be avoided.

For history, possible causes, and investigation, see Apparent life-threatening events Chapter 6.

Outcome and risk of sudden infant death syndrome

  • In infants with idiopathic ALTE, the outcome is not predictable.

  • The link between ALTE and SIDS is unclear.

  • Most infants dying of SIDS have not had previous ALTE.

  • In follow-up studies of infants with ALTE, there is a small increased risk of sudden death (about 1%), which appears to be highest in infants with recurrent episodes requiring resuscitation.

  • Survivors of idiopathic ALTE have normal neurodevelopmental performance at follow-up.

  • Parents of infants with ALTE should be taught basic life support.

Role of monitoring

  • Where a cause for the ALTE is found and treated, the problem has usually been addressed, and home monitoring is not indicated.

  • Where no cause has been found, the use of home monitoring remains controversial. The following points should be borne in mind.

    • Deaths have been reported, despite the use of monitors.

    • Most monitors are simple movement detectors and will not detect obstructive events.

    • Monitors can cause heightened anxiety as a result of repeated false alarms.

    • Parents using monitors need regular follow-up and technical support.

  • Where monitors are used, they need to combine respiratory and cardiac surveillance. Repeated false alarms will be detected for nearly all infants.