ALTE: A Four-Letter Word?
Through the use of a representative case study and discussion the authors review the appropriate workup of apparent life-threatening events—one of the most concerning pediatric presentations to the ED.
Case Conclusion
The infant in this case was a full-term, healthy male, older than 1 month of age, with no significant findings on physical examination. He had never had a prior ALTE. Though this episode started with a choking sound following a feeding, the EP correctly recognized this presentation as an ALTE based on parental history of the event.
The EP appropriately ordered a chest X-ray to exclude foreign body aspiration or aspiration pneumonia. The X-ray was unremarkable and, based on the physical examination and history, there was no indication requiring additional workup of this patient. After a discussion with the patient’s mother, the EP admitted the infant to pediatric services for overnight evaluation. The patient had no further apneic episodes during admission, but did have reflux after most feeds. No further interventions were required during the hospital stay, and the infant was discharged home the following day after parental education on home management of infantile GERD.
Dr Clingenpeel is a fellowship director of pediatric emergency medicine, and an associate professor of pediatrics, Eastern Virginia Medical School, Norfolk. Dr Eason is a pediatric emergency medicine fellow at Eastern Virginia Medical School, Norfolk.
