Apparent life-threatening event

Apparent Life-Threatening Event (ALTE) is a term used in medicine to describe a sudden, alarming episode in an infant that is frightening to the caregiver. This term has been largely replaced by the more recent term, Brief Resolved Unexplained Event (BRUE), to better describe these episodes when no cause is found after evaluation. ALTE was characterized by some combination of apnea (cessation of breathing), color change (usually pale or blue), marked change in muscle tone (limpness or stiffness), choking, or gagging. The exact cause of an ALTE could be varied, ranging from non-serious to life-threatening conditions.

Definition

The American Academy of Pediatrics (AAP) defined an ALTE as an episode that is frightening to the observer and is characterized by some combination of apnea, color change, muscle tone alteration, choking, or gagging. This definition was intentionally broad, encompassing a wide range of events and conditions.

Causes

The causes of ALTEs are diverse and can be classified into several categories including gastrointestinal, neurological, respiratory, infectious, cardiac, metabolic, and endocrine disorders, as well as child abuse or neglect. Some specific conditions that might lead to an ALTE include gastroesophageal reflux disease (GERD), seizures, respiratory infections, and pertussis.

Diagnosis

The diagnosis of an ALTE starts with a thorough history and physical examination, focusing on the details of the event as described by the caregiver. Laboratory tests, imaging studies, and specialist consultations may be used to identify the underlying cause. In many cases, however, no cause is found, and the event is then classified as a BRUE.

Management

Management of an ALTE depends on the underlying cause, if identified. In cases where no cause is found, management may focus on monitoring and supportive care. Education of the caregivers about safe infant care practices and the importance of monitoring for future episodes is also crucial.

Transition to BRUE

In 2016, the AAP recommended transitioning from the term ALTE to BRUE for events that are less severe and have no identifiable cause after an appropriate evaluation. This change was made to help better categorize these events, guide management, and reduce unnecessary interventions for benign and self-limiting episodes.

See Also

• Sudden Infant Death Syndrome (SIDS)
• Gastroesophageal Reflux Disease (GERD)
• Seizure
• Respiratory Infection