Apparent life-threatening events in children: practical evaluation and management.

Overview

Apparent life-threatening events account for 0.6% to 0.8% of all emergency department visits for children aged < 1 year. Risk factors for serious underlying pathology in a well-appearing infant have been identified as prematurity, underlying medical conditions, age < 60 days (considered controversial), suspicion of child abuse, possible seizure activity, and recurrent apparent life-threatening events. A detailed history and physical examination is crucial for the management of these patients. Targeted testing is warranted, as there is little evidence to support routine testing. A period of inpatient observation is often appropriate, as well. This review seeks to: (1) present actors that may place a patient at higher risk for serious underlying disease and/or a future adverse event requiring intervention; (2) provide guidance on taking a thorough history; and (3) describe guidelines for diagnostic testing and admission to the hospital for infants with an apparent life-threatening event.