Sudden infant death syndrome (SIDS) is the most common cause of mortality for babies between 1 and 12 months of life. Trying to identify which infants presenting with apparent life threatening events (ALTE) may go on to experience this horrible outcome is a challenge for the emergency physician. This article will highlight some steps to make the choice of investigative options and the disposition decision-making process a bit easier.

Definition

While arguments have been raised recently as to the relevance of ALTE in predicting SIDS, the importance of this controversy remains low for the emergency physician. The fact remains that, until proven otherwise, infants presenting to the emergency department with an ALTE might be experiencing the only event that may enable the health care system to identify and prevent impending SIDS. The term ALTE refers to a condition in which an acute, unexpected event that frightens the caregiver occurs, usually in an infant. The event includes changes in the breathing pattern or color (e.g., pallor or cyanosis), with or without a change in muscle tone. With this definition being so broad, subjective, and all encompassing, emergency physicians face challenges even in identifying these patients.

History

During their first year of life, an estimated 1% of babies will experience an ALTE. The vast majority of these patients present to the emergency department with anxious and frightened caregivers. The emergency physician’s task is to identify patients with the highest risk of recurrence or mortality. This is best defined with a thorough history of the event, previous medical history, risk assessment for SIDS, and family history. Investing the time required for a thorough investigation of the history is clearly worthwhile. The description of the event will influence decision making far more than any other part of the physician–patient interaction (i.e., lab tests, imaging, etc.).¹

It takes time to establish a good sense of the event. The questions in the history are aimed at determining if a significant apneic episode occurred. Eliciting a detailed description of the event should include these questions:²