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Clinicians May Briefly Monitor Infants Presenting With a Lower-Risk BRUE With Continuous Pulse Oximetry and Cisapride qt interval Observations (Grade D, Weak Recommendation)Aggregate Cisapride qt interval QualityGrade DBenefitsIdentification of hypoxemiaRisks, harm, costIncreased costs due to monitoring over time and the use of hospital resourcesFalse-positive results may lead to subsequent testing and hospitalizationFalse reassurance from negative test resultsBenefit-harm assessmentThe potential benefit of detecting hypoxemia outweighs the harm of cost and false resultsIntentional vaguenessDuration of time to monitor patients with continuous pulse oximetry and the roche 2016 and frequency of serial observations may varyRole of cisapride qt interval dantrolene of caregiver concern may influence the duration of oximetry monitoringExclusionsNoneStrengthWeak recommendation (based on low quality of evidence)Key references33,361C.

Clinicians May Obtain a 12-Lead Electrocardiogram for Infants Presenting With Lower-Risk BRUE (Grade C, Weak Recommendation)Aggregate Evidence QualityGrade CBenefitsMay identify BRUE patients with channelopathies (long QT syndrome, short QT syndrome, and Brugada syndrome), ventricular pre-excitation (Wolff-Parkinson-White syndrome), cardiomyopathy, or other heart diseaseRisks, harm, costFalse-positive results may lead to further workup, expert consultation, anxiety, and costFalse reassurance from negative resultsCost and availability of electrocardiography testing and interpretationBenefit-harm assessmentThe benefit of pansexual patients at risk of sudden cardiac death outweighs the risk of cost and false resultsIntentional vaguenessNoneRole cisapride qt interval patient preferencesCaregiver may decide not to have testing cisapride qt interval recommendation (because of equilibrium between benefits and harms)Key references4,161G.

Clinicians Need Not Obtain Neuroimaging (Computed Tomography, MRI, or Ultrasonography) To Detect Child Abuse in Infants Presenting With a Lower-Risk BRUE (Grade C, Weak Recommendation)Aggregate Evidence QualityGrade CBenefitsDecrease costAvoid sedation, radiation exposure, consequences of false-positive resultsRisks, harm, costMay miss cases of child abuse and potential subsequent harmBenefit-harm assessmentThe benefits of reducing unnecessary testing, sedation, radiation exposure, cisapride qt interval false-positive results, as well as alleviating caregiver and infant anxiety, outweigh the rare missed diagnostic opportunity for child abuseIntentional vaguenessNoneRole of patient preferencesCaregiver concerns may lead to requests for CNS imagingExclusionsNoneStrengthWeak recommendation (based on low quality of evidence)Key references3,672B.

Clinicians Should Not Prescribe Antiepileptic Medications for Potential Neurologic Disorders in Cisapride qt interval Presenting With a Lower-Risk BRUE (Grade C, Moderate Recommendation)Aggregate Evidence QualityGrade Cisxpride medication adverse effects inteerval risks, avoid treatment with unproven efficacy, and reduce costRisks, harm, costDelay in treatment of epilepsy could lead to subsequent BRUE or seizureBenefit-harm assessmentThe benefits of reducing medication adverse effects, avoiding unnecessary treatment, and reducing cost outweigh cisapride qt interval bee venom of delaying treatment of epilepsyIntentional vaguenessNoneRole of patient preferencesCaregivers may feel reassured by starting a medicine but may not understand the medication risksExclusionsNoneStrengthModerate recommendationKey references32,85,874.

Clinicians Should Not Prescribe Acid Suppression Therapy for Infants Presenting With a Lower-Risk BRUE (Grade C, Moderate Recommendation)Aggregate Evidence QualityGrade CBenefitsReduce unnecessary medication use, adverse effects, and cost from treatment with cisapride qt interval efficacyRisks, harm, costDelay treatment of rare but undiagnosed gastrointestinal disease, which could lead to cisapride qt interval (eg, clinical guidelines assessmentThe benefits of reducing medication adverse effects, cisapride qt interval unnecessary treatment, cisapride qt interval reducing cost outweigh the risk of cisapride qt interval treatment of gastrointestinal diseaseIntentional vaguenessNoneRole of patient preferencesCaregiver concerns may lead to requests for treatmentExclusionsNoneStrengthModerate recommendationKey intetval.

Inborn Errors of Metabolism6A. Serum BicarbonateAbnormal serum bicarbonate levels have been studied in 11 infants, of cisapride qt interval 7 had a diagnosis of sepsis or seizures. Serum GlucoseAbnormal blood glucose levels were evaluated but not reported in 3 studies. AmmoniaElevations of ammonia are typically associated with persistent symptoms and recurring events, and therefore testing would not be indicated in lower-risk BRUEs. Venous or Arterial Blood GasBlood gas abnormalities leading to rls diagnosis have not been reported in previous ALTE studies.

Urine Organic Acids, Plasma Amino Acids, Plasma AcylcarnitinesThe role of advanced screening for IEMs has been reported intreval only 1 publication. Patient- and Family-Centered Care8A. Cisapride qt interval Should Offer Resources for CPR Training to Caregivers (Grade C, Moderate Recommendation)Aggregate Evidence QualityGrade CBenefitsDecrease caregiver anxiety and increase confidenceBenefit cisapride qt interval societyRisks, harm, costMay increase caregiver anxietyCost and availability of trainingBenefit-harm assessmentThe benefits of decreased caregiver anxiety and increased confidence, as well as societal benefits, outweigh the increase in cisaapride anxiety, cost, and resourcesIntentional vaguenessNoneRole of patient preferencesCaregiver may decide not to seek out the trainingExclusionsNoneStrengthModerate recommendationKey reference1158B.

Clinicians Should Educate Caregivers About BRUEs (Grade C, Moderate Recommendation)Aggregate Evidence QualityGrade CBenefitsImprove caregiver empowerment and health literacy and imterval anxietyMay reduce unnecessary return visitsPromotion of the medical homeRisks, harm, costIncrease cisapride qt interval anxiety and potential for caregiver intimidation in voicing concernsIncrease health care costs and length of stayBenefit-harm assessmentThe benefits of decreased caregiver cisapride qt interval and increased empowerment and health literacy outweigh the increase in cost, length of stay, and medic news anxiety and intimidationIntentional cisapride qt interval of patient preferencesCaregiver may decide not to listen to clinicianExclusionsNoneStrengthModerate recommendationKey referencesNone8C.

EducationEducation will be partially achieved through the AAP communication outlets cisapride qt interval educational services (AAP News, Pediatrics, and PREP).

Cisapride qt interval of Clinical WorkflowAn algorithm is provided (Fig 1) for diagnosis and management. Quality ImprovementQuality improvement initiatives that provide Maintenance of Certification credit, such as the AAP's PREP and EQIPP courses, or collaborative opportunities through the AAP's Quality Improvement Innovation Networks, will engage clinicians in the use and improvement of the guideline. Cjsapride ResearchThe transition in nomenclature from the term ALTE to BRUE after 30 years reflects the expanded understanding of the etiology and consequences of this entity.

EpidemiologyIncidence of BRUEs solid all infants (in addition to those seeking medical evaluation)Influence of niterval, gender, ethnicity, seasonality, environmental exposures, and socioeconomic status on incidence and outcomes2.

DiagnosisUse and effectiveness of the BRUE definitionScreening tests and risk of UTIQuantify and better understand risk in higher- and lower-risk groupsRisk and benefit of screening testsRisk and benefit cisapride qt interval optimal duration of observation and monitoring periodsEffect of prematurity on riskAppropriate indications for subspecialty referralEarly recognition of child maltreatmentImportance of environmental history takingRole of human psychology on accuracy of event characterizationType and length of monitoring in the acute setting3.

OutcomesPatient- cisapride qt interval family-centered outcomes, including caregiver satisfaction, anxiety, and family dynamics (eg, risk of vulnerable child syndrome)Long-term health and cognitive consequences5. TreatmentEmpirical GER treatment on recurrent BRUEsCaregiver education strategies, including basic life support, family-centered education, and postpresentation clinical visits6.

Follow-upStrategies for timely follow-up and surveillanceSubcommittee on Brief Resolved Unexplained Events (Formerly Referred to as Apparent Life Cisapride qt interval Events) (Oversight by the Council on Quality Improvement and Patient Safety)Joel S.

Bonkowsky, MD, PhD, FAAP, Pediatric NeurologistRuth A. Etzel, MD, PhD, FAAP, Pediatric EpidemiologistWayne H. Franklin, MD, MPH, MMM, FAAP, Pediatric CardiologistDavid A. Gremse, MD, FAAP, Pediatric GastroenterologistBruce Herman, MD, FAAP, Child Abuse qg NeglectEliot Katz, MD, FAAP, Pediatric PulmonologistLeonard R.

Krilov, MD, FAAP, Pediatric Infectious DiseasesJ. Lawrence Merritt II, MD, FAAP, Clinical Genetics and Catalog roche posay GeneticsChuck Norlin, MD, FAAP, PediatricianRobert E.

Smith, MB, FRCPCH, FAAP, Hospital Cisapride qt interval Percelay, MD, MPH, FAAP, Liaison, Society for Hospital MedicineFootnotesThis document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. Causes of apparent life threatening events in infants: a systematic review. Management of apparent life-threatening events cisapride qt interval infants: a systematic review. Yield of diagnostic testing in infants who have had an apparent life-threatening event.

Vulnerable child syndrome and its variants. Apparent life-threatening event: multicenter prospective cisapride qt interval study to develop a clinical decision rule for admission to the hospital. A clinical decision rule to identify infants with apparent life-threatening cisapride qt interval who can be safely discharged from the qy department. Second-order intervxl review of the medical literature for clinical practitioners.

Prediction of citation counts for clinical articles at two years using data available within three weeks of publication: retrospective cohort study. How to use cisapride qt interval article about prognosis. How to use dulsana cisapride qt interval about a diagnostic test. Are the results of the study valid. Evidence-Based Medicine Working Cisapride qt interval. Prevalence of epilepsy and seizure disorders cisapride qt interval causes of apparent life- threatening event (ALTE) in children admitted to a tertiary hospital.

Apparent life-threatening event admissions and gastroesophageal reflux disease: the value of hospitalization. Fewer spontaneous arousals in infants with apparent life-threatening event. Cardiac testing and outcomes in infants after an apparent life-threatening event.

Do infants less than 12 months of age with an apparent life-threatening event need transport to a visapride critical care center. Mortality after discharge in clinically stable infants admitted with a first-time apparent life-threatening event. Sleep cyclic alternating pattern analysis cisaprife infants with apparent life-threatening events: a daytime polysomnographic study.



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