Apparent Life-Threatening Event (ALTE) in Infants with Esophageal Atresia

This is a review of present knowledge on ALTE in infants with esophageal atresia 65 years after its first report. Three different clinical presentations have been described. The most frequent form is characterized by recurrent episodes of upper airway obstruction followed by a sudden respiratory arrest. The second clinical presentation is characterized by sudden respiratory arrest not associated with signs of airways obstruction. The third form is characterized by a severe bradycardia not associated with apnea and followed by cardiac arrest. A maturational dysautonomia affecting respiratory and cardiac rhythm regulation appears to play an important pathogenetic role. ALTE may progress to sudden death; therefore, it requires treatment. Underlying disorders currently considered to be surgically correctable causes of ALTE include gastroesophageal reflux, tracheomalacia, and upper airway instability.