Table 3.

Information on ALTE and Surveillance

Case
No.
SexApparent Life-threatening EventsCVSOutcome for
Patient
Onset
(Months)
Reported
(n)
Documented
Unwell
(n)
SeverityBleedingPetechiaeDurationAge
(Months)
Instrument
of
Suffocation
Other Abnormal
Observations
Under
Surveillance
1M42119CPR ×2, hypoxic convulsionsNoNo18 H20T-shirtAggressive to child when staff not presentAdopted
2F166CPR ×1, pale, sweating, tachycardiaNoseNo4 H6VestNoneSevere self-multilation, pinches, fingers in throat, head-banging/long-term care to father
3F2.499CPR ×5, fitsMouthNo2 D5Domestic plastic film, then pillowDisconnected monitorsAdopted
4F3.8109CPR ×4, cyanosed, shockedNoFace and scalp12 D7HandPoor interactionReturned to parents
5M10.22419CPR ×7NoConjunctivae,
neck ×2
24 H17HandNoneAdopted
6M1.298No CPR, acidoticNoNo2 D3DuvetDisinterested unless nurse or doctor presentAdopted
7F4.277CPR ×3, hypotonic, cold, shockedNoNo1.5 H5Fingers down throat induced vomiting ×2Said she was feeling teeth during event, then joked with nurses/rough handling/bit through monitor lead to disconnect itAdopted
8M4.5139CPR ×3, acidotic, fitsNoNo45 Min6HandNoneFostered
9F4> 507No CPR, cyanosed, hypotonicMouthNo15 Min9HandNoneFostered
10M1.166CPR ×3, cyanosedNoNo24 H8HandSwore at patient/unusual kissingAdopted; mother changed name and left country, becoming pregnant on 2 occasions; both children into care on being discovered.
11M11010CPR ×5, zero value on Tcpo2 signal > 4 minNoseNo3 H3DuvetNoneSevere behavior disorder, learning difficulties, cerebral palsy; long-term care to father
12F0.71010CPR ×5NoNo29 H4HandNot recordedReturned to mother (grandmother was perpetrator)
13M1.677CPR ×2, pneumothorax
and pneumodiastinum
Nose and mouthNo9 H (alone 15 min)6HandsVerbal abuseCare by maternal grandparents
14F32.577CPR ×2, cyanosed, fitsNoNo36 H (mother
home at night)
35HandsNoneCerebral palsy, anticonvulsant for fits; adopted; mother admitted 12 episodes of suffocation
15F15.377CPR ×1, acidotic, cyanosedNoNo3 H, 15 min17HandsLittle contact; baby cried, slapped and told to shut upCare by paternal grandparents
16M3.995CPR ×3NoNo47 H9HandSlapped 5×, lacked interaction in nurses' absenceCare by father
17F3.3> 137CPR ×3, fitNoNo26 H, 30 min13SweaterNoneCare by father; mother left country
18M11.566CPR ×2, stridor, cyanosedNoNo43 H13FabricChanged from suffocation to cuddling when nurse entered; episode of struggling resulted in red mark around neckCare by father
19F11.580CPR ×1, cyanosedNose and mouthNo9 H17HandNoneLong-term foster care; mouth injury admitted to by mother
20M3.554CPR ×3, status epilepticus needing thiopentone infusion; focal fits with ↓ SaO2NoNo4 H, 40 min4Fingers up nose, handNoneAnticonvulsant for fits, cerebral palsy, behavioral problems, cortical blindness; care by maternal grandparents
21M3.699CPR ×3NoNo50 Min5Hands and clothNoneCare by maternal grandmother
22M0.744CPR ×1NoNo9 D2HandSee case historyCare by mother (father was perpetrator)
23F2.144CPR ×2NoNo60 H3BibSwitched off monitor; slapped twice; forced dummy into mouthLong-term foster care; mother changed name and became pregnant; identified after verbally abusing a child in the street; subsequent baby adopted
24F1.276CPR ×1, cyanosed, shockedNose and mouthNo3 H3NoneFractured left ulna and radius; verbally aggressive (see log); shook babyAdopted, subsequent baby removed
25M8.155CyanosedNose and mouthLips33 H9HandHit on face; smacked; swore at childLong-term foster care
26M10.484CPR ×1, cyanosedNoNo49 H, 30 min13HandDisturbed child from sleep and hit around the head 5×; inattentive to babyCare by father
27F10.842Pale, floppyMouthNo49 H19PillowPrepared blankets for suffocationCare by paternal grandparents
28M10.3> 101Cyanosed, floppyNoNo4 D15HandShaken roughly when cried; little interest when alone; overtly affectionate in presence of nursesAdopted
29F1.422ShockedNoNo9 D5NonePushed head into pillow; repeatedly rough handling; some shaking but not violent; swore at babyLong-term foster care (to mother's foster parents)
30FNoneN/AN/ANot relevantNoFace, neck, chest ×36 D20NoneNone; normal loving relationship between mother and child; very little observation of father aloneCare by mother (father was thought to be perpetrator of fractures and petechial hemorrhages)
31F0.2> 351Alleged “pale, fighting for breath, blue, vomited”NoNo5 D27NoneHitting child on mouth ×2; fabrication of ALTE, fit; alleged oedema hands and faceCare by mother under social services care order
32FNoneN/AN/ANot relevantNoNo6 H44NoneToothbrush rammed down throat, probably to induce vomiting; gave disinfectant via nasogastric tubeLong-term foster care
33M4.852CPR ×2, IPPV for 15 days, bloody pulmonary oedema at intubation, thereafter O2 dependent, fitsNoseNo70 H9HandMother discontinued his oxygen; swore at him; smacked him; pulled off bib roughly; he seemed frightened by his motherAdopted; home oxygen required for lung damage resulting from ventilation required for ALTE attributable to suffocation
34F0.1> 52CPR ×1, acidotic, cyanosedNoNo77 H18PillowSee log and case historyAdopted
35MNoneN/AN/ANot relevant; alleged fitsNoNo6 H34HandPoisoning with carbamazepine (see case history)Adopted by maternal grandparents
36F1.31712CPR ×6, “nearly dead” according to father, cyanosedNoNo15 D14NonePoor emotional interaction with patient unless father or nurses were presentReturned to care of parents after interim care order but no full court hearing of evidence; ALTE did not occur after CVS
37F3.665CPR ×1, cyanosedNoseNo7 D5NoneNo informationLong-term care by maternal grandmother
38M1.753CPR ×2, shockedNoNo3 H (parents together)2NoneNoneLong-term foster care, anticonvulsants for residual fits; mother eventually admitted suffocation
39M0.5> 252CPR ×2, O2given by paramedic at mother's request, she falsely alleged performing CPRNoNo25 H9NoneWarned about CVS by phone; put one of child's meals in bin (instead of feeding infant)Returned to care of mother
  • The number of ALTE reported refers to information received from the parents and must be considered with caution. In many cases, however, the numbers concurred with those reported by the referring hospital. Information on whether the child was unwell during events was more objective, originating from paramedics, nurses, and doctors.