Plan

A. Initial Management. Assess ABCs and correct any problems. Intervene for any life-threatening conditions (eg, meningitis).

B. Monitoring. A period of hospital monitoring is often recommended for infants with ALTE. Selected infants, in whom ALTE can be well characterized as an observer's overreaction to a normal episode, may be discharged home with good follow-up.

C. Medical and Nonmedical Therapies. Medical therapy for any newly diagnosed condition should be established and explained, as well as any nonmedical therapies (eg, reflux precautions). In OSAS resulting from adenotonsillar hypertrophy, adenotonsillec-tomy is usually curative; weight loss is recommended if child is obese.

D. Discharge Planning. Parents and other caregivers of infants with ALTE should undergo CPR training. Review safe infant sleep practices, most importantly supine sleep in a safe crib environment.

E. Home Cardiorespiratory (Apnea) Monitors. Use of home apnea monitors for infants with ALTE is recommended by some centers, but this remains an area of controversy. If prescribed, the monitor should have an event recorder, so that any further episodes at home can be correlated with data recorded on the monitor. It should be emphasized, however, that apnea monitors have never been shown to prevent SIDS and that prospective identification of SIDS is not possible. Monitor should be prescribed only as long as is necessary and should be discontinued if no further episodes occur or after any episodes have resolved. Continued episodes in otherwise healthy or treated infants are uncommon and warrant reevaluation.

F. Airway Support. For patients with OSAS, airway support can be provided by continuous or bilevel positive airway pressure (CPAP

or BiPAP) administered with a nasal mask. Supplemental oxygen therapy should be used with care, however, because blunting of the hypoxic drive to breathe in a child with CO2 retention due to OSAS can theoretically worsen obstructive hypoventilation.

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