Evaluation of Apparent Life-Threatening Events in Infants

A comprehensive, detailed history and physical examination with pulse oximetry and nondilated funduscopy (to look for traumatic retinal hemorrhage) helps to determine the underlying etiology of an apparent life-threatening event (ALTE) in 70 percent of infants. (Strength of Recommendation [SOR]: C, based on case series). Initial diagnostic evaluation should include 12-lead electrocardiography (ECG); blood gas analysis; chest radiography; complete blood count (CBC); pertussis and respiratory syncytial virus cultures, if respiratory symptoms are present; serum electrolytes; and urinalysis. (SOR: C, expert opinion and case series)

Infantile Apparent Life-Threatening Events, an Educational Review

Many physicians have received a frantic call from anxious parents stating that their child had stopped breathing, become limp, or turned blue but then had recovered quickly. An apparent life-threatening event (ALTE) is defined as “an episode that is frightening to the observer, and is characterized by some combination of apnea, color change, marked change in muscle tone, choking, gagging, or coughing”. The incidence of ALTE is reported to be 0.05% to 6%. The knowledge about the most common causes and factors associated with higher risk of ALTE could be resulted in a more purposeful approach, improving the decision making process, and benefiting both children and parents. The aim of this review article was to report the epidemiology, etiology, evaluation, management, and disposition of ALTE. Infants with an ALTE might present no signs of acute illness and are commonly managed in the emergency settings that often require significant medical attention; hence, the emergency medicine personnel should be aware of the its clinical importance. There is no specific treatment for ALTE; therefore, the clinical evaluations should be focused on the detection of the underlying causes, which will define the outcomes and prognosis. ALTE is a confusing entity, representing a constellation of descriptive symptoms and signs; in other words, it is not a diagnosis. There are multiple possible etiologies and difficulties in evaluating and managing infants with these events, which are challenges to primary care physicians, emergency medicine specialists, and subspecialty pediatricians. The evaluation of these events in infants includes a detailed history, appropriate physical examination, diagnostic tests guided by obtained clues from the history and physical examination, and observation in the emergency department

Death Anxiety and Well-Being; Coping With Life-Threatening Events

Research was conducted among people who have experienced trauma to see the influence of coping factors on death anxiety, PTSD, and psychiatric comorbidity. The intent was to consider the role of death anxiety in relationship to PTSD and mental health among people who have experienced a life-threatening event. It examined both self-efficacy and religious coping as possible factors of death anxiety resilience in relation to trauma. This study was conducted using undergraduate university students in Lithuania. The study (N = 104) did not find evidence to support the significance of religious coping as important factor; however, self-efficacy emerged as significantly related to psychiatric comorbidity and death anxiety. However the results found that self-efficacy did not act as a mediating factor and was independently related to death anxiety and psychiatric comorbidity. Results were discussed in light of theories regarding death anxiety and the agentic model. © The Author(s) 2013

Reducing Pulse Oximetry False Alarms Without Missing Life-Threatening Events

Alarm fatigue has been increasingly recognized as one of the most significant problems in the hospital environment. One of the major causes is the excessive number of false physiologic monitor alarms. An underlying problem is the inefficient traditional threshold alarm system for physiologic parameters such as low blood oxygen saturation (SpO2). In this paper, we propose a robust classification procedure based on the AdaBoost algorithm with reject option that can identify and silence false SpO2 alarms, while ensuring zero misclassified clinically significant alarms. Alarms and vital signs related to SpO2 such as heart rate and pulse rate, within monitoring interval are extracted into different numerical features for the classifier. We propose a variant of AdaBoost with reject option by allowing a third decision (i.e., reject) expressing doubt. Weighted outputs of each weak classifier are input to a softmax function optimizing to satisfy a desired false negative rate upper bound while minimizing false positive rate and indecision rate. We evaluate the proposed classifier using a dataset collected from 100 hospitalized children at Children\u27s Hospital of Philadelphia and show that the classifier can silence 23.12% of false SpO2 alarms without missing any clinically significant alarms

Surveillance study of apparent life-threatening events (ALTE) in the Netherlands

SIDS and ALTE are different entities that somehow show some similarities. Both constitute heterogeneous conditions. The Netherlands is a low-incidence country for SIDS. To study whether the same would hold for ALTE, we studied the incidence, etiology, and current treatment of ALTE in The Netherlands. Using the Dutch Pediatric Surveillance Unit, pediatricians working in second- and third-level hospitals in the Netherlands were asked to report any case of ALTE presented in their hospital from January 2002 to January 2003. A questionnaire was subsequently sent to collect personal data, data on pregnancy and birth, condition preceding the incident, the incident itself, condition after the incident, investigations performed, monitoring or treatment initiated during admission, any diagnosis made at discharge, and treatment or parental support offered after discharge. A total of 115 cases of ALTE were reported, of which 110 questionnaires were filled in and returned (response rate 97%). Based on the national birth rate of 200,000, the incidence of ALTE amounted 0.58/1,000 live born infants. No deaths occurred. Clinical diagnoses could be assessed in 58.2%. Most frequent diagnoses were (percentages of the total of 110 cases) gastro-esophageal reflux and respiratory tract infection (37.3% and 8.2%, respectively); main symptoms were change of color and muscle tone, choking, and gagging. The differences in diagnoses are heterogeneous. In 34%, parents shook their infants, which is alarmingly high. Pre- and postmature infants were overrepresented in this survey (29.5% and 8.2%, respectively). Ten percent had recurrent ALTE. In total, 15.5% of the infants were discharged with a home monitor. In conclusion, ALTE has a low incidence in second- and third-level hospitals in the Netherlands. Parents should be systematically informed about the possible devastating effects of shaking an infant. Careful history taking and targeted additional investigations are of utmost importance

ASSESSMENT OF RISK IN PRETERM INFANTS USING POINT PROCESS AND MACHINE LEARNING APPROACHES

Preemies, infants who are born too soon, have a higher incidence of Life-Threatening Events (LTE’s) such as apnea (cessation of breathing), bradycardia (slowing of heart rate) and hypoxemia (oxygen desaturation) also termed as ABD (Apnea, Bradycardia, and Desaturation) events. Clinicians at Neonatal Intensive Care Units (NICU) are facing the demanding task of assessing the risk of infants based on their physiological signals. The aim of this thesis is to develop a risk stratification algorithm using a machine-learning framework with the features related to pathological fluctuations derived from point process model that will be embedded into the current physiological recording system to assess the risk of life-threatening events well in advance of occurrence in individual infants in the NICU. We initially propose a point process algorithm of heart rate dynamics for risk stratification of preterm infants. Based on this analysis, point process indices were tested to determine whether they were useful as precursors for life-threatening events. Finally, a machine-learning framework using point process indices as precursors were designed and tested to classify the risk of preterm infants. This work helps to predict the number of bradycardia events, N, in the subsequent hours measuring point process indices for the current hour. The model proposed uses Quadratic Support Vector Machine (QSVM), a machine learning classifier, which can solve class optimization problems and execute data at an exponential speed with higher accuracy for risk assessment that might facilitate effective management and treatment for preterm infants in NICU. The findings are relevant to risk assessment by analyzing the fluctuations in physiological signals that can act as precursors for the future life-threatening events

Role of Rhinovirus C in Apparently Life-Threatening Events in Infants, Spain

To assess whether infants hospitalized after an apparently life-threatening event had an associated respiratory virus infection, we analyzed nasopharyngeal aspirates from 16 patients. Nine of 11 infants with positive virus results were infected by rhinoviruses. We detected the new genogroup of rhinovirus C in 6 aspirates

Preparedness for Life-Threatening Situations in a Pediatric Tertiary-Care University Children's Hospital: A Survey.

Pediatric nurses and physicians are rarely exposed to life-threatening events. Understanding the needs of clinicians is key for designing continuing training programs. A survey exploring preparedness to manage life-threatening events as well as training needs was mailed to all clinically active nurses and physicians at a tertiary-level referral children's hospital. Overall, 469 participants out of 871 answered the questionnaire (54% response rate). Respondents felt well or very well (nurses 93%, physicians 74%) prepared to recognize a deteriorating child and rated their theoretical understanding (70% well or very well prepared) of how to manage life-threatening situations significantly higher (p < 0.0001) than their cardiopulmonary resuscitation (CPR) preparedness (52% well or very well prepared). Both perceived theoretical understanding (p < 0.0001) and CPR preparedness (p < 0.002) were rated higher among nurses than physicians. Arrhythmias, shock, cardiac arrest and airway management constitute main areas of perceived training need. In conclusion, although a majority of pediatric nurses and physicians felt sufficiently trained to recognize a deteriorating child, their perceived ability to actively manage life-threatening events was inferior to their theoretical understanding of how to resuscitate a child. A high degree of institutional confidence and identification of areas of training need provide a good foundation for customizing future continuing education programs

Occupational Stress: Some Background with Ideas for Organizational Change

[Excerpt] What is stress? Dr. Hans Selye, an early researcher on stress, defined it as “the wear and tear caused by living.” Since it is part of life, we cannot avoid it – at work and in our personal lives. In today’s world, we experience situations and circumstances that are typically not really life-threatening. Or we worry about things that might happen or go wrong, but may never actually occur. Our bodies respond to these situations using our natural survival mechanisms – yet these can be an over-response because they evolved to deal with life-threatening events. In many ways, you could say that we are living in the bodies of our ancestors, but in a very different world. We inherited the adaptive responses that enabled them to survive