68 - Sudden Infant Death Syndrome, Brief Resolved Unexplained Events and Apparent Life-Threatening Events, and Apnea of Prematurity

Abstract

This chapter deals with early-life disorders which include anomalies of the control of breathing. Acute cardiorespiratory events experienced by infants, for which no cause is found, belong to a spectrum, which goes from brief, resolved, unexplained event (BRUE) to apparent life-threatening event (ALTE). The importance of recognizing a low-risk BRUE is that it does not require further investigation, while the diagnosis of a high-risk BRUE or an ALTE calls for further targeted testing and consideration for monitoring. Apneas of prematurity are present in about 50% of all premature infants and virtually universal in preterm infants born at less than 28 weeks gestation. Although the most severe are life-threatening and require prolonged respiratory support, apneas of prematurity have generally disappeared at term equivalent age, such that pediatric societies recommend limiting the use of home cardiorespiratory monitoring. Sudden infant death syndrome (SIDS) remains a dramatic, unexplained, and unexpected event which, in more than 80% of the cases, is not preceded by apneas of prematurity or BRUE/ALTE. An inherent vulnerability of the autonomic nervous system of various origins is a major component of the triple-risk model of SIDS, which also includes a critical period of development and a triggering event such as an infection or an unsafe bed environment. Identification of newborns at risk for SIDS, in order to develop preventive measures, remains a high priority.