FPIN's clinical inquiries. Evaluation of apparent life-threatening events in infants.

A comprehensive, detailed history and physical examination with pulse oximetry and nondilated funduscopy (to look for traumatic retinal hemorrhage) helps to determine the underlying etiology of an ALTE in 70 percent of infants. (Strength of Recommendation [SOR]: C, based on case series). Initial diagnostic evaluation should include 12-lead electrocardiography (ECG); blood gas analysis; chest radiography; complete blood count (CBC); pertussis and respiratory syncytial virus cultures, if respiratory symptoms are present; serum electrolytes; and urinalysis. (SOR: C, expert opinion and case series). If the initial evaluation does not reveal the underlying etiology of an ALTE, then the following tests should be performed: a barium-contrast upper gastrointestinal series or gastric pH probe to evaluate for reflux; computed tomography of the head or a skeletal survey to evaluate for occult cases of deliberate harm; and electroencephalography (EEG) to help diagnose seizure disorders. (SOR: C, expert opinion and case series).