with an Apparent Life-Threatening Event


Possible causes


Symptoms and findings


Suggested studies


Gastrointestinal causes


 GERD


 Aspiration


Vomiting


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


Trauma


 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


Microcephaly/macrocephaly


Dysmorphia


EEG


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


Seizures


Feeding difficulties


Consciousness compromise


Dysmorphia


Glycemia


Lactate, ammonium, pyruvate


Aminoacidemia, aminoaciduria, etc.


Cardiovascular causes


 Congenital heart disease


 Arrhythmia


Feeding difficulties


Diaphoresis


Central cyanosis, syncope


ECG (QTc)


24-hour Holter monitoring


Doppler echocardiography


Infectious causes


 Meningitis


 Septicemia


 UTI


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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