Patologias associadas e prognóstico de eventos com aparente risco de vida (ALTE)

Abstract

Objective

To verify the etiology and prognosis of apparent life threatening events (ALTE) in infancy, and their possible association with sudden infant death syndrome (SIDS). Methods: We studied a group of infants who presented ALTE episodes and were evaluated in our hospital. First we reviewed their clinical history and polysomnography findings, and then we sent the families a letter with questions about the outcome. Results: Our study comprised 56 patients: 92% had ALTE during their first 6 months of life, and 83% in the first trimester. Symptomatic ALTE predominated (71%). The disease most frequently associated was gastroesophageal reflux, followed by neurological diseases. Follow-up showed 51.5% normal outcome, 4 children with repeated ALTE, and no cases of SIDS. Conclusions: Multifactorial etiologies can be associated with ALTE, and the outcome is generally determined by the associated disease. We did not observe any relationship between ALTE and SIDS in a predominantly symptomatic ALTE population.

Methods

We studied a group of infants who presented ALTE episodes and were evaluated in our hospital. First we reviewed their clinical history and polysomnography findings, and then we sent the families a letter with questions about the outcome. Results: Our study comprised 56 patients: 92% had ALTE during their first 6 months of life, and 83% in the first trimester. Symptomatic ALTE predominated (71%). The disease most frequently associated was gastroesophageal reflux, followed by neurological diseases. Follow-up showed 51.5% normal outcome, 4 children with repeated ALTE, and no cases of SIDS. Conclusions: Multifactorial etiologies can be associated with ALTE, and the outcome is generally determined by the associated disease. We did not observe any relationship between ALTE and SIDS in a predominantly symptomatic ALTE population.

Results

Our study comprised 56 patients: 92% had ALTE during their first 6 months of life, and 83% in the first trimester. Symptomatic ALTE predominated (71%). The disease most frequently associated was gastroesophageal reflux, followed by neurological diseases. Follow-up showed 51.5% normal outcome, 4 children with repeated ALTE, and no cases of SIDS. Conclusions: Multifactorial etiologies can be associated with ALTE, and the outcome is generally determined by the associated disease. We did not observe any relationship between ALTE and SIDS in a predominantly symptomatic ALTE population.

Conclusions

Multifactorial etiologies can be associated with ALTE, and the outcome is generally determined by the associated disease. We did not observe any relationship between ALTE and SIDS in a predominantly symptomatic ALTE population.

Resumen

Objetivo

Verificar a etiologia e o prognóstico dos episódios de ALTE na infância e sua possível relação com a Síndrome da Morte Súbita do Lactente.

Métodos

Estudo de uma coorte de crianças que apresentaram episódios de ALTE e foram avaliadas no Serviço de Neurologia do Hospital São Lucas da PUCRS. Primeiramente foram revisados os prontuários contendo a avaliação clínica e as polissonografias. Prospectivamente os pacientes foram contatados e reavaliados através de questionário.

Resultados

Foram incluídos neste estudo 56 pacientes investigados entre os anos de 1985 a 1996. Em 92% dos casos o episódio ocorreu nos primeiros seis meses de vida, 83% antes dos três meses. Houve um predomínio de episódios sintomáticos (71 %) em relação aos idiopáticos. A patologia mais freqüentemente associada aos episódios de ALTE foi refluxo gastro-esofágico, seguido de causas neurológicas. No seguimento dessas crianças, 51,5% foram consideradas normais, quatro repetiram outros episódios de ALTE, nenhuma evoluiu para Síndrome da Morte Súbita do Lactente (SMSL).

Conclusões

Nossos resultados sugerem que a etiologia dos episódios de ALTE pode estar associada a inúmeros distúrbios, e o prognóstico está associado à patologia de base. Não observamos relação entre ALTE e SMSL considerando-se uma população com episódios de ALTE predominantemente sintomáticos.