I took care of a kid for something I had never heard of: ALTE, an apparent life-threatening event. Essentially it's an episode of coughing, gagging, not breathing, or turning blue, in an infant, which scares the caregiver. The "scared caregiver" seems important because it's usually benign, but the pediatrician or ER has to try to figure it out, and ALTE is the diagnosis-in-the-meantime.
My ALTE infant (15 days old) had a choking episode and couldn't get his breath back for a minute or so, so the parents brought him to the ER. The ER thought it was a simple case of overfeeding (the mother was breastfeeding and then giving formula). However, he spiked a temp, and his urine culture was positive for ampicillin-resistant E. coli. UTIs are also a possible cause of ALTEs, but the amp-resistant variation is sort of a hospital thing, which might mean he acquired it here or it was a contaminated sample. (Truly clean urine samples are not easy to get on infants!) And he's a boy—UTIs are a little rare in boys, right? So he was worked up for the UTI and had to stay a week, but it still sounds like it was might have been a benign episode of overfeeding/choking and a coincidental fever, maybe from mild dehydration or stress of hospitalization. This is why I'm reluctant to bring my kids to the hospital: you have to be so cautious with children (is it a bad sample? or is it a UTI which will travel up to his kidneys and destroy them within a day?) that the residents will keep you there forever.
ALTE is not to be confused with SIDS. It is commonly called a "missed SIDS" or an "aborted crib death" by some nurses and doctors—the presumption is that it's a case of SIDS that was interupted by a watchful caregiver. However, ALTE has different causes than SIDS, i.e. digestive problems or stress rather than respiratory problems or deep sleep and being left alone. My textbook claims that less than 6-7% of SIDS cases had a previous ALTE.
I've been a Pediatric RN for 5 years. In my experience 99% of ALTE's are just reflux. Very, very rarely are they actually an issue. "But you gotta bring em in for observation just to be sure."
ReplyDeleteYeah, I definitely don't like bringing my children to the ER because I KNOW what will happen to them. When my second daughter was a newborn her respiratory rate would often go up 70-110 breaths per minute. It scared the crap out of me. But the thought of an LP, cathed urine, an IV, and all the labs scared me worse (our ER is terrible with newborns, taking several attempts usually).
(Found your blog through The True Face of Birth)
My son had an ALTE while in the NICU. Lots of problems, was a 27 weeker, but was 3 months old at the time and a feeder/grower. Had been off oxygen for 2 weeks, very few A&B's. His nurse at the time was by his bedside when she saw him arch his back, go purple and then gray (all before the 20 second delay in the monitors and before they went off) and then just went limp. It was 20 minutes before he needed to be fed so an empty stomach and they didn't consider reflux a factor here. Had to do chest compressions and bag him before his heart rate came back up to 60 and then recovered from there.
ReplyDeleteEverything came back normal, x-rays, blood work and there was never any explanation for what happened. He's 2 years old now and hasn't had anything since but it was really odd and a little frustrating they weren't able to determine what happened. His nurse commented that if it had happened at home, you could have been in the same room as him and not known what happened since he never made a sound. She stated it would have probably been rules as SIDS but the fact she was right there and took action immediately probably saved him.
Just thought I'd share an experience in a hospital setting with an ALTE.