ALTE

Apparent Life-Threatening Event (ALTE) refers to an acute, unexpected episode in which an infant exhibits clinical symptoms that are alarming to the caregiver and suggest a life-threatening condition, although the event resolves on its own or with intervention. The term ALTE has been largely replaced by the more recent term Brief Resolved Unexplained Event (BRUE) in medical literature to more accurately describe these episodes without implying a near-miss sudden infant death syndrome (SIDS).

Definition

An ALTE is characterized by some combination of apnea (cessation of breathing), color change (usually pallor or cyanosis), marked change in muscle tone (usually limpness), choking, or gagging. The definition was established to help healthcare providers better identify infants who had an episode that frightened the observer and could indicate a serious underlying condition.

Causes

The causes of ALTE are varied and can be classified into several categories including gastrointestinal (such as gastroesophageal reflux), neurological (such as seizures), respiratory (such as respiratory infections or airway abnormalities), cardiovascular, metabolic, and infectious. In many cases, however, a specific cause for an ALTE is not identified.

Management

The management of an ALTE involves a thorough history and physical examination, and possibly diagnostic testing, to identify any underlying conditions. The approach to management is highly individualized based on the suspected cause of the event. In some cases, hospitalization may be necessary for monitoring and further evaluation.

Transition to BRUE

In 2016, the American Academy of Pediatrics (AAP) introduced the term Brief Resolved Unexplained Event (BRUE) to replace ALTE. This change was made to better describe these events without implying an imminent risk of death and to provide a more clear guideline for the evaluation and management of infants who experience such episodes. BRUE is defined as an event occurring in an infant younger than one year when the observer reports a sudden, brief, and now resolved episode of one or more of the following: cyanosis or pallor; absent, decreased, or irregular breathing; marked change in tone (hypertonia or hypotonia); and altered level of responsiveness.

Conclusion

While the term ALTE is being phased out in favor of BRUE, understanding the concept of ALTE is important for recognizing the clinical presentation of these events. Early identification and appropriate management of infants who experience an ALTE or BRUE can help prevent future episodes and identify underlying conditions that may require treatment.