with an Apparent Life-Threatening Event

Possible causes

Symptoms and findings

Suggested studies

Gastrointestinal causes




Blockage or coughing with food

pH metry

Video swallow study

Speech therapy assessment

Respiratory causes

 Viral infection/pertussis

 Aspiration/foreign body

 Anatomical airway alteration

Cor yza, cough, wheezing, fever, hypothermia

History of foreign body ingestion

Stridor, feeding difficulties, dysmorphisms (especially craniofacial dysmorphisms)

Viral panel, viral DIF

PCR testing for Bordetella

Endoscopic airway evaluation


 Munchhausen syndrome by proxy

History of trauma, blood in the mouth or nose

Previous ALTE, SIDS in a sibling, discordant history

Radiological clinical evaluation

Rule out abuse

Clinical suspicion

Neurological/convulsive causes

Loss of consciousness

Eye deviation

Seizure, hypotonia/hypertonia




Brain echocardiogram

CT scan/brain MRI

Glycemia; Ca, P, Mg, PLD levels

Metabolic study

Emotional apnea

Suggestive clinical history without other findings (while awake)

Rule out associated anemia

Metabolic causes

Family history


Feeding difficulties

Consciousness compromise



Lactate, ammonium, pyruvate

Aminoacidemia, aminoaciduria, etc.

Cardiovascular causes

 Congenital heart disease


Feeding difficulties


Central cyanosis, syncope


24-hour Holter monitoring

Doppler echocardiography

Infectious causes




Fever, hypothermia, lethargy, and/or shock

Hemogram, blood culture PCR, complete urine, urine culture

Lumbar puncture

Medications or toxicity

Consciousness compromise

Lethargy, previous history

Toxicology screening of blood and/or urine

CT computerized tomography, DIF direct immunofluorescence, ECG electrocardiogram, EEG electroencephalogram, GERD gastroesophageal reflux disease, MRI magnetic resonance imaging, PCR polymerase chain reaction, PLD phospholipase D, QTc corrected QT interval, SIDS sudden infant death syndrome, UTI urinary tract infection

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Nov 7, 2020 | Posted by in Uncategorized | Comments Off on with an Apparent Life-Threatening Event
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