ALTE/BRUE and SIDS

Question 1

What does ALTE/BRUE stand for?

Answer 1

• = Apparent Life Threatening Event (ALTE) / Brief resolved unexplained event (BRUE)

Question 2

What can an ALTE/BRUE involve?

Answer 2

• apnoea(central or obstructive)
• colour change(cyanotic, pallid, or plethoric)
• change in muscle tone(usually diminished but may be stiffening)
• choking or gagging

Question 3

Peak age of presentation of ALTE/BRUE

Answer 3

~3mo i.e. infants

Question 4

Most common cause of ALTE/BRUE, and why it occurs.

Answer 4

Exaggerated physiological airway protection reflexes
○ E.g. against developing respiratory infections

○ In young infants the laryngeal chemoreceptor cough reflex is not well matured
○ ingress of saliva/feed/refluxed gastric contents into the laryngeal inlet instead of just stimulating a cough will sometimes trigger apnoea

• Also commonly occurs during feeding/after physiological reflux

Question 5

Relationship between ALTE and SIDS

Answer 5

none

Question 6

Red flags for more serious cause of ALTE:

Answer 6

• Age less than 28 days
• Significant prematurity
• Significant prior medical illness
• Clinically unwell looking.
• Recurrent events before presentation
• More severe/prolonged ALTE symptoms

Question 7

Risk factors for SIDS

Answer 7

• Infant
• Age 1-6 month (peak 3 months)
• LBW/preterm
• M > F
• Multiple births
• Higher birth order
• Parent
• Maternal age < 20 years
• Maternal smoking during pregnancy and after birth
• Environment
• Lower SES
• Sleeping prone
• Winter months (history of coryzal Sx)
• Overheating

Question 8

Some points for preventing SIDS

Answer 8

• Smoking cessation
• Do not overheat the baby
• Baby must sleep in a safe cot, not other alternatives
• Keep baby away from cords that could get caught around neck
• Keep heaters or electrical appliances away
• Sleep on back, head uncovered
• Bedding: try safe infant sleeping bag, if not, make sure baby at end of bed with bedding firmly tucked in so it can’t ride up
• Ensure no soft bedding
• No co-sleeping
• Safe wrapping
• Encourage tummy time