Know Your Guidelines – Infant with Brief Apneic Event

Andrea Eberly, MD, MS, FAAEMEmergency Medicine, Guideline Knowledge Check, Pediatric Emergency Medicine, Pediatric Medicine

ALTE BRUE guidelines knowledge check

Clinical Guideline Knowledge Check:
Infant with Brief Apneic Event

The 2016 American Academy of Pediatric (AAP) Guidelines changed both the terminology and management of apparent life-threatening episodes (ALTE) in infants.

Do you know the most recent guidelines for the management of infants with ALTE?

Stay in step with current national guidelines with Med-Challenger Guideline Knowledge Checks.

Today’s Guideline Knowledge Check question comes from the desk of Med-Challenger Emergency Medicine Editor-in-Chief, Andrea Eberly, MD, FAAEM.

Test your knowledge of the most current ALTE Guidelines with this case...

Case Question:

A 14-week-old male infant is brought in by his mother to see you after the mother witnessed a self-limited episode of apnea accompanied by cyanosis during crying (see image).

The infant was born at full term, and the event lasted less than 1 minute. No cardiopulmonary resuscitation (CPR) was performed, and such episodes have never happened before.

The patient currently appears well, and he has normal vital signs and alertness. History and physical examination findings are unrevealing for any underlying cause of the apneic event.

Fig. 1 A 14-week-old infant with cyanosis.

ALTE current AAP guidelines

According to the 2016 American Academy of Pediatrics (AAP) recommendations, which of the following is an appropriate management of this patient's apneic episode?

Answer Options:

Check urinalysis and electrolytes; if both are normal, discharge patient to home cardiorespiratory monitoring until 6 months old.

Given the patient’s age, perform a septic work-up including lumbar puncture; if negative, monitor the child’s cardiorespiratory status in the ED for 4-6 hours.

Educate mother about the risk level of her infant’s event and give her training resources for CPR; recommend discharge without further testing or observation.

Given the patient’s age, admit for sepsis work-up and 24 hours of cardiorespiratory monitoring

Answer Explanation & References:

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About the Author:

Andrea Eberly, MD, FAAEM graduated from the David Geffen Medical School of Los Angeles (UCLA) and completed her residency in Emergency Medicine at the University Medical Center, Tucson, Arizona. After working as an attending physician in Tucson, she followed a recruiting call to the island of Guam, where she served in various roles, including as the director of the emergency department, the EMS Medical Director of Guam, and the Director of the 911 Call System. She has maintained her emergency medicine board certification through three cycles of American Board of Emergency Medicine Board Exams (last in 2014), all three with the help of Med-Challenger.