UMEM Educational Pearls

Category: Pediatrics

Title: ALTE (submitted by Jim Lantry, MD)

Keywords: apparent life threatening event (PubMed Search)

Posted: 5/18/2012 by Mimi Lu, MD
Click here to contact Mimi Lu, MD

There has been no link found between Sudden Infant Death Syndrome (SIDS) and an Acute Life Threatening Event (ALTE)

There are several factors that dispute previous claims of each being manifestations of the same disease state:

1)      Timing: approx 75-80% of  SIDS deaths occur between midnight and 6 AM; 80-85% of  ALTE occur between 8 AM and 8 PM 

2)      Prevention: Interventions to prevent SIDS (ex, “back to sleep”) have not resulted in a decreased incidence of ALTE

3)      Risk factors:

a.       SIDS: prone sleeping, bottle feeding, maternal smoking

b.      ALTE: repeated apnea, pallor, history of cyanosis, feeding difficulties


BONUS PEARL: A thorough history and physical will lead to the diagnosis for the source of the ALTE in 21%

Pertinent historical items: detailed bystander history of event (parents, EMS), activity and behavior prior to event and any past medical issues or medications (focus on GERD and pulmonary)

Pertinent physical exam: detailed neurological and cardiopulmonary system eval with focus on signs of non-accidental trauma (retinal hemorrhaging, bulging fontanel, bruising) as up to 10% of ALTEs involve some form of abuse


1) Blair, PS. Et. Al. Major epidemiological changes in sudden infant death syndrome: a 20-year population-based study in the UK. The Lancet. 2006; 367(9507):314-319
2) Moon, RY, Horne, RSC, Hauck, FR.  Sudden Infant Death Syndrome. The Lancet. 2007; 370(9598):1578-1587
3) McGovern MC, Smith MBH. Causes of apparent life threatening events in infants: a systematic review. Archive Diseases of Childhood. 2004; 89:1043-8.
4) U Kiechl-Kohlendorfer,U, Hof, D, Pupp Peglow, U, Traweger-Ravanelli, B, Kiechl.  Epidemiology of apparent life threatening events. Archive of Diseases of Childhood. 2005; 90:297-300