APPARENT LIFE-THREATENING EVENTS IN PRESUMED HEALTHY NEONATES DURING THE FIRST 3 DAYS OF LIFE

Objective. To study the historical, clinical, and pneumographic correl ates of apparent life-threatening events (ALTEs) in a term newborn nur sery population during the first 3 days of life in a maternity hospita l. Methods. Twenty newborns with ALTEs during the first 3 days of life were studied. Family, antenatal, and intrapartum histories were revie wed. Diagnostic and therapeutic data surrounding the ALTEs were docume nted. Multichannel recordings performed after the ALTEs occurred were analyzed. Hospital discharge dispositions and postdischarge outcomes w ere reviewed. Results. Of approximately 15 000 deliveries during a thr ee-year period, 20 infants had ALTEs. Apnea was the most common presen ting symptom, and cyanosis usually accompanied the event. Tactile stim ulation and oxygen were the most frequent acute treatments, with airwa y clearance, intermittent positive pressure ventilation, and cardiac m assage less common. Forty percent of the events had potentially identi fiable causes, including central nervous system abnormality, airway ob struction, or a persistent fetal cardiovascular shunt. Of the initial multichannel recordings, 11 had desaturation of less than 85%, 10 had apneic pauses of greater than 15 seconds, and 4 had bradycardia of les s than 80 beats per minute. Eighteen infants were discharged and recei ved home monitors; 4 received medication. ALTEs recurred in 4 infants before discharge and in 1 after discharge. No deaths occurred. Conclus ions. (1) ALTEs do occur in the early newborn period in a low-risk ter m group; (2) causes are unknown in the majority of cases; (3) multicha nnel recordings may have abnormalities; and (4) the likelihood of recu rrent ALTEs is greater during the first week than during the next 2 mo nths.