OTOLARYNGIC MANIFESTATIONS IN CHILDREN PRESENTING WITH APPARENT LIFE-THREATENING EVENTS

Apparent life-threatening event (ALTE) is a term used to characterize an event of unknown cause after an infant is found limp, cyanotic, bra dycardic, and/or requiring resuscitation. Like sudden infant death syn drome (SIDS), ALTE is a general term used until a precise diagnosis ca n be established. The relationship between ALTE and SIDS has not been clearly defined, although 7 to 15 percent of children with ALTE die of SIDS. If children with ALTE are at greater risk for SIDS, morbidity a nd mortality may be prevented if the underlying pathology can be ident ified and corrected or closely monitored, The otolaryngologist is bein g consulted more frequently to evaluate children who have been through an ALTE to help elucidate any underlying pathology that may have caus ed the near-death experience, This retrospective chart review reports the evaluation of 30 infants with ALTE requiring consultation by the D ivision of Pediatric Otolaryngology at the Children's Memorial Hospita l in Chicago during a 3-year period, We reviewed the literature and he re compare our findings with current animal models. Of the 30 children evaluated, 53% had gastroesophageal reflux, 40% had laryngeal abnorma lities, 13% had tracheal abnormalities, and 10% had pharyngeal abnorma lities. Thirteen percent of the children had nonotolaryngic anomalies identified during evaluation, Surgical intervention was required in 10 patients and medical treatment was used in 18. When evaluating a chil d with ALTE, a complete history and physical examination, evaluation f or gastroesophageal reflux, assessment for upper airway obstruction by radiographs and endoscopy and a multidisciplinary approach are recomm ended.