📋 ALTE Definition
• Apparent life-threatening event: acute event with some combination of apnea, color change (cyanosis/pallor), bradycardia, choking/gagging
• Replaces "near-miss SIDS" – no clear association with SIDS
• 50% have identifiable etiology after thorough H&P
🫁 Central vs Obstructive Apnea
• Central: no respiratory effort
• Obstructive: effort present but airway blocked (e.g., laryngomalacia, choanal atresia, OSA)
• Mixed: both components
⚠️ Red Flags & Serious Causes
• Child abuse: inflicted neurotrauma, suffocation, poisoning; recurrent ALTEs with single caregiver
• Metabolic disorders: fasting-induced, altered mental status, family history infant deaths
• RSV: apnea can be first sign, minimal pulmonary findings in young infants
• Pertussis: paroxysmal cough with post-tussive apnea
🩺 Benign Mimics
• Breath-holding spells (cyanotic or pallid): ages 6-18 months, triggered by injury/frustration, brief LOC, rapid recovery
• Periodic breathing: 5-10 sec pauses followed by rapid breathing, no distress, common in premies
• GER: controversial causal role; pH study helpful if event captured
📌 Decision strategy: H&P guides evaluation. No consensus standardized workup. At least 50% of ALTEs have identifiable cause. Always consider child abuse, metabolic disorders, and RSV in infants. Breath-holding spells: treat iron deficiency.