Kurz R, Kenner T, Reiterer F, Schenkeli R, Haidmayer R, Stöckler S, Paschke E
Department of Pediatrics, University of Graz, Austraia.
Acta Paediatr Hung. 1990;30(3-4):435-47.
Near miss events or apparent life threatening events (ALTE) are considered preliminary stages of sudden infant death syndrome (SIDS). The current definition of near miss SIDS postulates that such an event happens unexpectedly and that no life threatening cause of disease can be detected. However in 32 of 34 observations of ALTE pathological changes actually could be identified by through investigations: 11 central nervous diseases, 10 respiratory tract disturbances, 5 metabolic abnormalities, 5 disturbances of the digestive tract and 1 cardiac disease. There were 22 morphologically manifested causes as opposed to 10 functional failures mainly respiratory control and oesophageal disturbances. Irrespective of the main diagnosis sleep apnea syndrome (SAS) could be detected in 17 of 28 infants combined with bradycardia in 5 cases, and oesophageal disturbances in 16 of 17 infants. Four babies later died, two of them suffered from carnitine deficiency and one from organic acidopathy. It is our conclusion that numerous, even banal causes of disease are able to trigger ALTE if there is a coincidence with phases of increased instability of vital regulatory mechanisms of autonomous centres in infants.
近距 misses事件或明显危及生命事件（ALTE）被认为是婴儿猝死综合征（SIDS）的初步阶段。当前对近距 misses SIDS的定义假定此类事件意外发生且无法检测到危及生命的病因。然而，在对34例ALTE的观察中，有32例通过调查实际上可以确定病理变化：11例中枢神经系统疾病、10例呼吸道紊乱、5例代谢异常、5例消化道紊乱和1例心脏病。有22例形态学上表现出的病因，而主要是呼吸控制和食管紊乱的10例功能衰竭。无论主要诊断如何，28例婴儿中有17例检测到睡眠呼吸暂停综合征（SAS），其中5例伴有心动过缓，17例婴儿中有16例存在食管紊乱。4名婴儿后来死亡，其中2名患有肉碱缺乏症，1名患有有机酸血症。我们的结论是，如果与婴儿自主中枢生命调节机制不稳定增加的阶段同时发生，许多甚至平常的病因都能够引发ALTE。
