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

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, SD±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.