ALTE and Infections - when to do full septic workups?

Given some recent cases of newborns with ALTEs at UMMS and Wash Co I thought I'd offer the following Pearls:   

• Overall the number of children with bacterial meningitis or bacteremia / sepsis as a cause of the ALTE is very low, much less than 1%
• However there is no data regarding the risk of meningitis in a well-appearing, afebrile infant with an ALTE

That being said THE RISK OF MISSING A SERIOUS LIFE THREATENING INFECTION is much greater than the risk of doing a complete septic workup, administering antibiotics, and admitting an infant with an ALTE.

 

 

 

References

McGovern MC, Smith MB. Causes of apparent life threatening events in infants: a systematic review. Arch Dis Child. 2004;89(11):1043-8.