09 SIDS

ALTE

• ALTE: Apparent life threatening events. Used to replace near SIDS. Episode of symptoms that's concerning for parent because change in color (cyanosis), tone (hypotonia), breathing (apnea) of infant.

Most of time just parents freaking out. Use hx to figure out

• GERD

• lower airway infection

• Seizure: abnormal eye movements, limb jerking

• watch out for:

  • sepsis: infected, fevers (change in temp)

  • heart problems: FTT, dysphagia, murmur

  • Abuse: multiple injuries

BRUE

• brief resolved unexplained event. Replaces ALTE

• criteria, must be unexplained change in color/tone/breathing/responsiveness:

  • infant < 1yo

  • brief, < 1 min

• 2 types if have BRUE:

  • Low risk: Do nothing

    • do not have history/PE worrisome for cyanosis, fever, abuse, no CPR required

    • 1st time and not recurring

    • age: > 60 days. Gestational > 32 wks, postconception > 45 wks

  • High risk: anything not low risk. Monitor and investigate

Examples

• respiratory symptoms, fever symptoms: not BRUE because > 1 min

• choking/gagging with spitting up: not BRUE because can be investigated and explained via GERD, infection

SIDS

• child dies for no reason

• prevention

  • back to sleep: infant on back (flatten occiput, turn head side to side on different nights)

  • don't share bed

  • smoking cessation

  • Do Not try to figure out who's gonna get it (EKG, pulse ox, apnea monitor)