The Long-Term Outcome of Infantile Apparent Life-Threatening Event (ALTE): A Follow-Up Study until Midpuberty

Abstract

The neurological long-term sequelae of an idiopathic apparent life-threatening event (ALTE) were studied in 14 ALTE cases and 12 controls (of similar sex, age, and maturation of puberty). One ALTE case had developed motor and severe learning disabilities. Four other cases and one control were judged as MND (minor neurological deficits). Touwen's neurological profile was less optimal in children with an ALTE history than in controls (p < 0.05). A high amount of associated movements were found in combination with an inability of certain gross motor functions, such as standing or hopping on one leg for sufficiently long or walking on tip-toes or on heels. Fine and gross motor performance tested with the Bruininks-Oseretsky test and behaviour judged with Connors' Rating Scales - Revised, were not different between ALTE cases and controls. Our study provides evidence of neurological long-term sequelae of ALTE.

Key words

Children - neurological examination - minor neurological deficits - behaviour - fine motor development - gross motor development

References

• 1 Altman R L, Brand D A, Forman S, Kutscher M L, Lowenthal D B, Franke K A. et al . Abusive head injury as a cause of apparent life-threatening events in infancy.  Arch Pediatr Adolesc Med. 2003;  157 1011-1015
• 2 Baroni M A. Apparent life-threatening events during infancy: a follow-up study of subsequent growth and development.  J Dev Behav Pedriatr. 1991;  12 154-161
• 3 Beal S. Apparent-life-threatening events with serious sequelae in infants and young children.  J Paediatr Child Health. 1992;  28 151-155
• 4 Black L, Steinschneider A, Sheehe P R. Neonatal respiratory instability and infant development.  Child Dev. 1979;  50 561-564
• 5 Brooks C. Apparent life-threatening events and apnea in infancy.  Clin Perinatol. 1992;  19 809-838
• 6 Bruininks R H. Bruininks Oseretsky Test of Motor Proficiency: Examiner's Manual. Circle Pines, MN; American Guidance Service 1978
• 7 Christophe C, Boutemy R, Christiaens F, Fonteyne C, Ziereisen F, Dan B. Value of brain MR imaging in infants with a severe idiopathic apparent-life-threatening event.  J Radiol. 2000;  81 25-32
• 8 Conners C K. Conners' Rating Scales - Revised. New York; Multi-Health Systems 1997
• 9 Constantinou J, Gillia J, Ouvrier R, Rahilly P M. Hypoxic-ischemic encephalopathy after near miss sudden infant death syndrome:.  Arch Dis Childh. 1989;  64 703-708
• 10 Coons S, Guilleminault C. Motility and arousal in near miss sudden infant death syndrome.  J Pediatr. 1985;  107 728-732
• 11 Davies F, Gupta R. Apparent-life-threatening events in infants presenting to an emergency department.  Emerg Med J. 2002;  19 11-16
• 12 De Piero A, Teach S J, Chamberlain J M. ED evaluation of infants after an apparent life-threatening event.  Am J Emerg Med. 2004;  22 83-86
• 13 Deykin E, Margaret L, Bauman L, Kelly D H, Hsieh C C, Shannon D. Apnea of infancy and subsequent neurologic, cognitive and behavior status.  Pediatrics. 1984;  73 638-645
• 14 Einspieler C. Abnormal spontaneous movements in infants with repeated sleep apnoeas.  Early Hum Dev. 1994;  36 31-48
• 15 Einspieler C, Prechtl H, van Eykern L, de Roos B. Observation of movements during sleep in ALTE (apparent-life-threatening event) and apnoeic infants - a pilot study.  Earl Hum Dev. 1994;  40 39-49
• 16 Farrell P A, Weiner G M, Lemons J A. SIDS, ALTE, apnea and the use of home monitors.  Pediatr Rev. 2002;  23 3-9
• 17 Guilleminault C, Korobkin R. Sudden infant death. Near miss events and sleep research. Some recommendations to improve comparability of results among investigators.  Sleep. 1979;  1 423-433
• 18 Guilleminault C, Souquet M, Ariagno R L, Korobkin R, Simmons F B. Five cases of near miss sudden infant death syndrome and development of obstructive sleep apnea syndrome.  Pediatrics. 1984;  73 71-78
• 19 Guilleminault C, Stoohs R. From apnea of infancy to obstructive sleep apnea syndrome in the young child.  Chest. 1992;  102 1065-1071
• 20 Jenkins R L. Indices for maternal/family anxiety and disruption related to infant apnea and home monitoring.  Hlth Care Women Int. 1996;  17 535-548
• 21 Kahn A, Verstraeten F, Blum D. Clinical and laboratory observations. Preliminary report on neurodevelopmental outcome in children previously at risk for sudden infant death.  J Pediatr. 1984;  105 666-668
• 22 Kahn A, Sottiaux M, Appelboom-Fondu J, Blum D, Rebuffat E, Levitt J. Long-term development of children monitored as infants for an apparent-life-threatening event during sleep: a 10-year follow-up study.  Pediatrics. 1989;  83 668-673
• 23 Kahn A. 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;  163 108-115
• 24 Korobkin R, Guilleminault C. Neurologic abnormalities in near miss for sudden infant death syndrome.  Pediatr. 1979;  64 369-374
• 25 Light M J, Sheridan M S. Psychosocial impact of emergency apnea.  Am J Dis Child. 1987;  141 668-671
• 26 Marshall W A, Tanner J M. Puberty. Davis JA, Dobbing J Scientific Foundations of Paediatrics. 2nd ed. London; Heinemann 1981: 176-209
• 27 McGovern M C, Smith M B. Causes of apparent life threatening events in infants: a systematic review.  Arch Dis Child. 2004;  89 1043-1048
• 28 Mitchell E A, Thompson J M. Parental reported apnoea, admissions to hospital and sudden infant death syndrome.  Acta Paediatr. 2001;  90 417-422
• 29 Nunes M L, Appel C C, da Costa J C. Apparent-life-threatening episodes as the first manifestation of epilepsy.  Clin Pediatr. 2003;  42 19-22
• 30 Okada K, Miyako M, Honma S, Wakabayashi Y, Sugihara S, Osawa M. Discharge diagnoses in infants with apparent life-threatening event.  Pediatr Int. 2003;  45 560-563
• 31 Poets C F. Apparent life-threatening events and sudden infant death on a monitor.  Paediatr Respir Rev. 2004;  5 S383-S386
• 32 Prechtl H FR, Ferrari F, Cioni G. Predictive value of general movements in asphyxiated fullterm infants.  Early Hum Dev. 1993;  35 91-120
• 33 Stratton S J, Taves A, Lewis R J, Clements H, Henderson D, McCollough M. Apparent life-threatening events in infants: high risk in the out-of-hospital environment.  Ann Emerg Med. 2004;  43 711-717
• 34 Tirosh E, Jaffe M. Apparent-life threatening event: a neurologic perspective.  J Child Neurol. 1995;  10 216-218
• 35 Tirosh E, Kessel A, Jaffe M, Cohen A. Outcome of idiopathic apparent life-threatening events: infant and mother perspectives.  Pediatr Pulmonol. 1999;  28 47-52
• 36 Touwen B CL. Examination of the Child with Minor Neurological Dysfunction. 2nd ed. Clin Dev Med, Vol. 71. London; Heinemann 1979