Published online July 1, 2008
PEDIATRICS Vol. 122 No. 1 July 2008, pp. 125-131 (doi:10.1542/peds.2007-3376)
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ARTICLE

Death, Child Abuse, and Adverse Neurological Outcome of Infants After an Apparent Life-Threatening Event

Joshua L. Bonkowsky, MD, PhDa, Elisabeth Guenther, MD, MPHb, Francis M. Filloux, MDa and Rajendu Srivastava, MD, FRCP, MPHc

Divisions of a Pediatric Neurology
b Pediatric Emergency Medicine
c Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah

OBJECTIVES. Apparent life-threatening events in infants constitute a significant challenge for health care providers. Apparent life-threatening event evaluation and management are poorly defined, and outcomes have not been clearly determined. Our objectives were to characterize short- and long-term risks for death, child abuse, and abnormal neurological outcomes of infants after an apparent life-threatening event and to identify clinical features that are predictive of these outcomes.

METHODS. We collected data from infants ages birth to 12 months of age who were hospitalized after an apparent life-threatening event during a 5-year time period. Patients were evaluated for subsequent death, child abuse, or adverse neurological outcome (chronic epilepsy or developmental delay).

RESULTS. A total of 471 patients met inclusion criteria and were followed an average of 5.1 years. Two patients died after developing chronic epilepsy and severe developmental delay. Fifty-four (11%) patients were diagnosed as being a victim of child abuse, but only 2 were identified at initial presentation. There were 23 (4.9%) patients with adverse neurological outcomes, including 17 (3.6%) with chronic epilepsy and 14 (3.0%) with developmental delay. Of those who developed chronic epilepsy, 71% returned within 1 month of the initial apparent life-threatening event with a second event. Neurological evaluation at the time of the apparent life-threatening event had low yield for predicting those who would develop chronic epilepsy.

CONCLUSIONS. Infants who suffer an apparent life-threatening event are at risk for subsequent child abuse and adverse neurological outcomes. Deaths were uncommon and only occurred in the setting of severe developmental delay and seizure disorders. Neurological evaluation during hospitalization for a first apparent life-threatening event is of low yield, but close follow-up is essential.

Key Words: ALTE • EEG • MRI • CT • seizures • SIDS • child abuse

Abbreviations: ALTE—apparent life-threatening event • SIDS—sudden infant death syndrome • CNS—central nervous system • GERD—gastroesophageal reflux disease • ICD-9-CM—International Classification of Diseases, Ninth Revision, Clinical Modification • EDW—Enterprise Data Warehouse • EEG—electroencephalogram • OR—odds ratio • PPV—positive predictive value • NPV—negative predictive value • CI—confidence interval • CT—computed tomography

Accepted Dec 14, 2007.


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