FREQUENCY AND RISK FACTORS OF BREAST FEEDING JAUNDICE IN ICTERIC NEWBORNS
Definition: ALTE is an episode that is frightening to observer and is characterized by some combination of apnea (central or occasionally obstructive) color change (usually cyanotic or pallid but occasionally erythematous or plethoric) marked change in muscle tone (usually marked limpness) choking, or gagging. Previously used terms of "aborted crib death" or "near miss SIDS," are no longer acceptable as they imply a close relationship between ALTEs and SIDS. The Incidence of this condition is 0.05 to 6% in infants (mostly <3 months) it makes 0.8 to 1% of emergency department visits of <1 year old patients and 12% of pediatric hospitalizations. Patients' history and physical examination are the most important parts of the evaluation. Moreover, the details of the event and the environment in which it happened are important. More than 80% of the patients look well after the episode; however, less than 20% of them have the signs and symptoms obviously requiring hospitalization. Risk factors for adverse outcomes in patients with ALTE include prematurity and more than one ALTE's significant medical problems in 24 hours. Etiology: About 50% of ALTEs fail to be explained after full work up and observation. The most common causes of ALTE include GE reflux, seizure, and respiratory infections. Work up and evaluation: Routine screening tests for GE reflux, sepsis, meningitis and seizures have low yield in infants who are well appearing. Limited and appropriate evaluations are encouraged, as there is no even minimal standard work up for ALTE. After careful evaluations, if the etiology or episode appears to be life threatening, patient needs hospitalization for observation and further work up. Conclusion: ALTE is a confusing entity representing a collection of descriptive symptoms and signs, not a diagnosis. Multiple possible etiologies of ALTE as well as difficulties in its evaluation and management are challenges for physicians. Taking detailed history and performing precise physical examination of the patient as well as making appropriate evaluations lead the physician to decide to hospitalize the patient or not.