Aggiornamento
Per una corretta gestione del bambino con ALTE
For a Correct management of ALTE in children
Alessandro Vigo1,2, Silvia Noce2, Aaldo Ravaglia3
1Centro per la Medicina del Sonno Pediatrica e per la SIDS, Pediatria Universitaria 1; 2Azienda Ospedaliera Cittŕ della Salute
e delle Scienze, Torino
3Pediatra di libera scelta, ASL TO4, Chivasso (Torino)
Maggio 2015 - pagg. 292 -297
Abstract
“Infants with an apparent life-threatening event (ALTE) present to medical attention because
of an acute and unexpected change in behaviour that alarmed the care giver. The
initial episodes can occur during sleep, awake, or feeding. They are most commonly described
as some combination of apnoea, colour change (cyanotic or pallid, occasionally
plethor), marked change in muscle tone (limpness, rarely rigidity), choking or gagging.
In most cases the observers reported that the episode appeared potentially life-threatening
or they thought the infant had died, and that a prompt intervention was associated
with normalisation of the child’s appearance. In some cases, the episode was of
short duration and resolved spontaneously” (Kahn A; European Society for the Study
and Prevention of Infant Death. Recommended clinical evaluation of infants with an apparet
life-threatening event. Consensus document of the European Society for the Study
and Prevention of Infant Death, 2003. Eur J Pediatr 2004;163:108-15).
Classificazione MeSH
Contenuto riservato
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Bibliografia
1. Kahn A; European Society for the Study and
Prevention of Infant Death. Recommended
clinical evaluation of infants with an apparent
life-threatening event. Consensus document
of the European Society for the Study and Prevention
of Infant Death, 2003. Eur J Pediatr
2004;163:108-15.
2. Kelly DH, Shannon DC, O’Connell K. Care
of infants with near-miss sudden infant death
syndrome. Pediatrics 1978;61(4):511-4.
3. Tieder JS, Altman RL, Bonkowsky JL, et al.
Management of apparent life-threatening
events in infants: a systematic review. J Pediatr
2013;163(1):94-9.e1-6.
4. Ventura A (a cura di). ALTE: il reflusso č
fuori gioco (Pagina gialla). Medico e Bambino
2014;33(7):421.
5. Kiechl-Kohlendorfer U, Hof D, Pupp Peglow
U, Trawengwe-Ravanelli B, Kiechl S. Epidemiology
of apparent life-threatening events.
Arch Dis Child 2004;90:297-300.
6. Semmekrot BA, van Sleuwen BE, Engelberts
AC, et al. Surveillance study of apparent
life-threatening events (ALTE) in the Netherlands.
Eur J Pediatr 2010;169:229-36.
7. www.epicentro.iss.it/regioni/piemonte/pdf/
INTEGRALE_MORTI_IMPROVVISE_PIEMO
NTE.pdf.
8. Oren J, Kelly D, Shannon DC. Identification
of a high-risk group for sudden infant death
syndrome among infants who were resuscitated
for sleep apnea. Pediatrics 1986;77:495-9.
9. Samuels MP, Poets CF, Noyes JP, Hartmann
H, Hewertson J, Southall DP. Diagnosis and infants and young children who received cardiopulmonary
resuscitation. BMJ 1993;306:
489-92.
10. Esani N, Hodgman JE, Ehsani N, Hoppenbrouwers
T. Apparent life-threatening events
and sudden infant death syndrome: comparison
of risk factors. J Pediatr 2008;152:365-70.
11. Darnall RA. ALTEs: still a puzzle after all
these years. J Pediatr 2009;154:317-9.
12. Horne RS, Nixon GM. The role of physiological
studies and apnoea monitoring in infants.
Paediatr Respir Rev 2014;15:312-8.
13. Piumelli R, Di Pietro P, Longhi L, et al. Assistential-
diagnostic guidelines: apparent lifethreatening
events (ALTE). Minerva Pediatr
2009;61(6):891-3.
14. Kant S, Fisher JD, Nelson DG, Khan S. Mortality
after discharge in clinically stable infants
admitted with a first-time apparent life-threatening
event. Am J Emerg Med 2013;31: 730-3.
15. Carroll JL. Apparent Life Threatening
Events (ALTE) Assessment. Pediatr Pulmonol
Suppl 2004;26:108-9.
16. Lucet V, de Bethmann O, Denjoy I. Paroxysmal
vagal overactivity, apparent life-threatening
event and sudden infant death. Biol
Neonate 2000;78(1):1-7.
17. Harrington C, Kirjavainen T, Teng A, Sullivan
CE. Altered autonomic function and reduced
arousability in apparent life-threatening
event infants with obstructive sleep apnea. Am
J Respir Crit Care Med 2002;165:1048-54.
18. Hunt CE. Ontogeny of autonomic regulation
in late preterm infants born at 34-37
weeks postmenstrual age. Semin Perinatol
2006;30:73-6.
19. Stock C, Teyssier G, Pichot V, Goffaux P,
Barthelemy JC, Patural H. Autonomic dysfunction
with early respiratory syncytial virus-related
infection. Auton Neurosci 2010;156:90-5.
20. Tirosh E, Ariov-Antebi N, Cohen A. Autonomic
function, gastroesophageal reflux in apparent
life threatening event. Clin Auton Res
2010;20:161-6.
21. Alkon A, Boyce WT, Davis NV, Eskenazi
B. Developmental changes in autonomic nervous
system resting and reactivity measures
in Latino children from 6 to 60 months of age.
J Dev Behav Pediatr 2011;32:668-77.
22. Hasenstab KA, Jadcherla SR. Respiratory
events in infants presenting with apparent life
threatening events: is there an explanation
from esophageal motility? J Pediatr 2014;165:
250-5.e1.
23. Ramanathan R, Corwin MJ, Hunt CE, et
al.; Collaborative Home Infant Monitoring
Evaluation (CHIME) Study Group. Cardiorespiratory
events recorded on home monitors:
Comparison of healthy infants with
those at increased risk for SIDS. JAMA 2001;
285(17):2199-207.
24. Bonkowski JL, Guenther E, Filloux FM, Srivastava
R. Apparent Life-Threatening Event.
Death, child abuse, and adverse neurological
outcome of infants after an apparent life-threatening
event. Pediatrics 2008;122:125.
25. DiMario FJ. Apparent Life-Threatening
Events: so what happens next? Pediatrics
2008;122:190.
26. Fu LY, Moon RY. Apparent life-threatening
events: an update. Pediatr Rev 2012;33(8):361-70.
27. Filonzi L, Magnani C, Nosetti L, et al. Serotonin
transporter role in identifying similarities
between SIDS and idiopathic ALTE. Pediatrics
2012;130(1):138-44.
28. Jadcherla SR, Hogan WJ, Shaker R. Physiology
and pathophysiology of glottic reflexes
and pulmonary aspiration: from neonates to
adults. Semin Respir Crit Care Med 2010;31
(5):554-60.
29. Byard RW, Beal SM. Gastric aspiration and
sleeping position in infancy and early childhood.
J Paediatr Child Health 2000;36:403-5.
30. Halbower AC. Pediatric home apnea monitors:
coding, billing, and updated prescribing
information for practice management. Chest
2008;134:425-9.
31. Committee on Fetus and Newborn. American
Academy of Pediatrics. Apnea, sudden infant
death syndrome, and home monitoring.
Pediatrics 2003;111(4 Pt 1):914-7.
32. Malloy MH, Graubard B. Access to home
apnea monitoring and its impact on rehospitalization
among very low birth weight infants.
Arch Pediatr Adolesc Med 1995;149:326-32.
33. Côté A, Hum C, Brouillette RT, Themens
M. Frequency and timing of recurrent events
in infants using home cardiorespiratory monitors.
J Pediatr 1998;312:783-9.
34. Doshi A, Bernard-Stover L, Kuelbs C,
Castillo E, Stucky E. Apparent life-threatening
event admissions and gastroesophageal reflux
disease-the value of hospitalization. Pediatr
Emerg Care 2012;28(1):17-21.
Corrispondenza: noce.silvia@yahoo.it