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Arch Dis Child. 2012 Dec;97(12):1034-8. doi: 10.1136/archdischild-2012-301668. Epub 2012 Sep 25.

Cardiac testing and outcomes in infants after an apparent life-threatening event.

Author information

  • 1Primary Children's Medical Center, Division of Pediatric Cardiology, Department of Pediatrics, University of Utah School of Medicine, 100 N. Mario Capecchi Drive, Salt Lake City, UT 84058, USA. nelangi.pinto@imail.org

Abstract

OBJECTIVES:

We sought to determine the yield of cardiac testing and to identify predictors of cardiac disease in infants with an apparent life-threatening event (ALTE).

DESIGN:

Retrospective longitudinal cohort study.

SETTING:

Paediatric hospital providing primary and tertiary care that is part of an integrated healthcare system.

PATIENTS:

Infants hospitalised for an ALTE from 1999 to 2003.

MAIN EXPOSURES:

Cardiac testing used at time of ALTE and results, and clinical risk factors for cardiac disease.

OUTCOME MEASURES:

Short-term (during hospitalisation) and long-term (through November 2009) follow-up for any diagnosis of significant cardiac anatomic or rhythm abnormality.

RESULTS:

Study criteria were met by 485 infants (mean age 1.9, SDĀ±2.2 months; 49% boys). Cardiac testing was performed on 219 (45%) patients during ALTE hospitalisation, identifying two patients with significant cardiac disease (cardiomyopathy, ventricular pre-excitation). During 7.7 years of follow-up, three additional significant cardiac diagnoses (ventricular pre-excitation, frequent ventricular ectopy, moderate aortic stenosis) were identified. All cardiac tests had low positive predictive value (PPV). Significant cardiac disease was associated with prematurity (22% vs 80%, p=0.002), but not age, gender, prior ALTE or rescue breaths.

CONCLUSIONS:

This longitudinal study of an ALTE cohort revealed significant cardiac disease in <1% of patients. Prematurity was the only clinical predictor identified. ECG was sensitive for identifying significant cardiac disease, but routine testing warrants further investigation because of the low PPV.

PMID:
23012307
[PubMed - indexed for MEDLINE]
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