Application of the BRUE Definition and Risk Stratification on an ALTE Population: a European Essay
Tóm tắt
Recent adapted guidelines on the approach of apparent life-threatening events (ALTE) propose a new definition of the phenomenon: brief resolved unexplained events (BRUE) and a risk stratification aimed at reducing unnecessary and expensive medical procedures. We applied the BRUE directives to a series of ALTE patients which required the intervention of the emergency medical service (ES) and/or the emergency department (ED) and were addressed to the Reference Center for Paediatric Sleep Medicine and Sudden Infant Death Syndrome in the Piedmont region between 2009 and 2015 to identify the number of BRUE cases and to classify them as lower or higher risk. We performed a retrospective file review. ALTE patients < 1 year admitted to a ES or ED were considered eligible; the American Academy of Pediatrics (AAP) Guidelines were used to identify BRUEs and to stratify them in lower and higher risk categories. A total of 790 ALTEs were eligible, 164/790 met the BRUE criteria; 62/164 were considered lower risk BRUE, according to their demographic features. Only few ALTEs matched the BRUE criteria in our study population (about 1/5). It was observed that demographic characteristics strongly influenced stratification to lower risk BRUE (8% of the initial sample group). Our data confirm that the AAP guidelines can be useful in the management of BRUE, but especially in the hands of well-trained and experienced physicians in this field.
Tài liệu tham khảo
National Institutes of Health Consensus Development Conference on Infantile Apnea and Home Monitoring, Sept 29 to Oct 1, 1986. Pediatrics. 1987;79:292–299.
Kahn A, European Society for the Study and Prevention of Infant Death. Recommended clinical evaluation of infants with an apparent life-threatening event. Consensus document of the European Society for the Study and Prevention of Infant Death, 2003. Eur J Pediatr. 2004;163:108–15.
Tieder JS, Bonkowsky JL, Etzel RA, Franklin WH, Gremse DA, Herman B, et al. Brief resolved unexplained events (formerly apparent life-threatening events) and evaluation of lower-risk infants. Pediatrics. 2016;37(5):e20160590.
Ramanathan R, Corwin MJ, Hunt C, Lister G, Tinsley LR, Baird T, et al. Cardiorespiratory events recorded on home monitors: comparison of healthy infants with those at increased risk for SIDS. JAMA. 2001;285(17):2199–207.
Kiechl-Kohlendorfer U, Hof D, Peglow UP, Traweger-Ravanelli B, Kiechl S. Epidemiology of apparent life threatening events. Arch Dis Child. 2005;90(3):297–300.
Semmekrot BA, van Sleuwen BE, Engelberts AC, Joosten KFM, Mulder JC, Liem KD, et al. Surveillance study of apparent life-threatening events (ALTE) in the Netherlands. Eur J Pediatr. 2010;169(2):229–36.
Meyer JS, Stensland EG, Murzycki J, Gulen CR, Evindar A, Cardoso MZ. Retrospective application of BRUE criteria to patients presenting with ALTE. Hosp Pediatr. 2018;8:740–5. https://doi.org/10.1542/hpeds.2018-0044.
Colombo M, Katz ES, Bosco A, Melzi ML, Nosetti L. Brief resolved unexplained events: retrospective validation of diagnostic criteria and risk stratification. Pediatr Pulmonol. 2019;54:61–5. https://doi.org/10.1002/ppul.24195.
Ramgopal S, Soung J, Pitetti RD. Brief resolved unexplained events: analysis of an apparent life threatening event database. Acad Pediatr. 2019;19:963–8.
Vigo A, Noce S, Ravaglia A. Per una corretta gestione del bambino con ALTE. Med Bambino. 2015;34:292–7.
WHO classification of Preterm birth. Available at: http://www.who.int/mediacentre/factsheets/fs363/en/. Accessed 12 Nov 2019.
Vigo A, Costagliola G, Ferrero E, Noce S. Hypotonic-hyporesponsive episodes after administration of hexavalent DTP-based combination vaccine: a description of 12 cases. Hum Vaccin Immunother. 2017;13(6):1–4. https://doi.org/10.1080/21645515.2017.1287642.
Fu LY, Moon R. Apparent life-threatening events: an update. Pediatr Rev. 2012;33:361–9.
Vigo A, Balagna R, Brazzi L, Costagliola G, Gregoretti C, Lupica MM, et al. Apparent life-threatening events: helping infants help themselves. Pediatr Emerg Care. 2018;34(8):545–51. https://doi.org/10.1097/PEC.0000000000000811.
Lucet V, de Bethmann O, Denjoy I. Paroxysmal vagal overactivity, apparent life-threatening event and sudden infant death. Biol Neonate. 2000;78(1):1–7.
Vigo A, Noce S, Costagliola G, Bruni O. Sleep-related risk and worrying behaviours: a retrospective review of a tertiary centre's experience. Eur J Pediatr. 2019;12:1841–7. https://doi.org/10.1007/s00431-019-03460-2.
Nino G, Govindan RB, Al-Shargabi T, Metzler M, Massaro AN, Perez GF, et al. Premature infants rehospitalized because of an apparent life-threatening event had distinctive autonomic developmental trajectories. Am J Respir Crit Care Med. 2016;194(3):379–81.
Brand DA, Fazzari MJ. Risk of death in infants who have experienced a brief resolved unexplained event: a meta-analysis. J Pediatr. 2018;197:63–7.