Bonkowsky Joshua L, Guenther Elisabeth, Filloux Francis M, Srivastava Rajendu
Department of Pediatrics, Division of Pediatric Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Pediatrics. 2008 Jul;122(1):125-31. doi: 10.1542/peds.2007-3376.
Apparent life-threatening events in infants constitute a significant challenge for health care providers. Apparent life-threatening event evaluation and management are poorly defined, and outcomes have not been clearly determined. Our objectives were to characterize short- and long-term risks for death, child abuse, and abnormal neurological outcomes of infants after an apparent life-threatening event and to identify clinical features that are predictive of these outcomes.
We collected data from infants ages birth to 12 months of age who were hospitalized after an apparent life-threatening event during a 5-year time period. Patients were evaluated for subsequent death, child abuse, or adverse neurological outcome (chronic epilepsy or developmental delay).
A total of 471 patients met inclusion criteria and were followed an average of 5.1 years. Two patients died after developing chronic epilepsy and severe developmental delay. Fifty-four (11%) patients were diagnosed as being a victim of child abuse, but only 2 were identified at initial presentation. There were 23 (4.9%) patients with adverse neurological outcomes, including 17 (3.6%) with chronic epilepsy and 14 (3.0%) with developmental delay. Of those who developed chronic epilepsy, 71% returned within 1 month of the initial apparent life-threatening event with a second event. Neurological evaluation at the time of the apparent life-threatening event had low yield for predicting those who would develop chronic epilepsy.
Infants who suffer an apparent life-threatening event are at risk for subsequent child abuse and adverse neurological outcomes. Deaths were uncommon and only occurred in the setting of severe developmental delay and seizure disorders. Neurological evaluation during hospitalization for a first apparent life-threatening event is of low yield, but close follow-up is essential.
婴儿的明显危及生命事件对医疗保健提供者构成重大挑战。明显危及生命事件的评估和管理定义不明确，结果也尚未明确确定。我们的目标是描述婴儿在经历明显危及生命事件后死亡、虐待儿童和神经学异常结果的短期和长期风险，并确定可预测这些结果的临床特征。
我们收集了在5年期间因明显危及生命事件住院的出生至12个月大婴儿的数据。对患者进行随访，观察其随后是否出现死亡、虐待儿童或不良神经学结果（慢性癫痫或发育迟缓）。
共有471名患者符合纳入标准，平均随访5.1年。两名患者在出现慢性癫痫和严重发育迟缓后死亡。54名（11%）患者被诊断为虐待儿童的受害者，但初次就诊时仅发现2例。有23名（4.9%）患者出现不良神经学结果，包括17名（3.6%）患有慢性癫痫和14名（3.0%）患有发育迟缓。在那些发展为慢性癫痫的患者中，71%在初次明显危及生命事件后的1个月内再次出现该事件。在明显危及生命事件发生时进行的神经学评估对预测哪些患者会发展为慢性癫痫的准确率较低。
经历明显危及生命事件的婴儿有遭受后续虐待儿童和不良神经学结果的风险。死亡情况不常见，仅发生在严重发育迟缓和癫痫发作障碍的情况下。因首次明显危及生命事件住院期间进行的神经学评估准确率较低，但密切随访至关重要。
