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Clinicians May Briefly Monitor Infants Presenting With a Hdl BRUE With Continuous Pulse Oximetry and Serial Observations (Grade D, Weak Hdl Evidence Hdl 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 hdl detecting hypoxemia outweighs the harm of cost and false resultsIntentional vaguenessDuration of time to hdl patients with continuous pulse oximetry and the number and frequency of serial observations may varyRole hdl patient preferencesLevel of caregiver concern may influence the duration of oximetry monitoringExclusionsNoneStrengthWeak recommendation (based on hdl quality of evidence)Key references33,361C.

Clinicians Hdl Obtain a 12-Lead Electrocardiogram hdl Infants Presenting With Lower-Risk BRUE (Grade C, Weak Recommendation)Aggregate Evidence QualityGrade Hdl 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 hdl, harm, costFalse-positive results may lead to further workup, hdl consultation, anxiety, and costFalse reassurance from negative resultsCost and availability of electrocardiography testing and interpretationBenefit-harm assessmentThe benefit of identifying patients at risk hdl sudden cardiac death outweighs the risk of cost and false resultsIntentional vaguenessNoneRole of hdl preferencesCaregiver may decide hdl to have testing performedExclusionsNoneStrengthWeak recommendation (because of equilibrium between benefits hdl harms)Key hdl. Clinicians Hdl Not Obtain Neuroimaging hdl Tomography, MRI, or Ultrasonography) To Detect Child Abuse in Infants Presenting With a Lower-Risk BRUE (Grade C, Hdl Recommendation)Aggregate Evidence QualityGrade CBenefitsDecrease costAvoid sedation, radiation exposure, consequences of false-positive resultsRisks, hdl, costMay miss cases of child abuse and potential subsequent harmBenefit-harm hdl benefits of reducing unnecessary testing, sedation, radiation exposure, and false-positive results, as well as hdl caregiver and infant anxiety, hdl the rare missed diagnostic opportunity for child abuseIntentional vaguenessNoneRole of patient preferencesCaregiver concerns may lead to requests for CNS imagingExclusionsNoneStrengthWeak recommendation hdl on low quality of evidence)Key references3,672B.

Clinicians Should V i h Prescribe Antiepileptic Medications for Potential Neurologic Disorders in Hdl Presenting With a Lower-Risk BRUE (Grade C, Moderate Recommendation)Aggregate Evidence QualityGrade CBenefitsReduce medication adverse effects and risks, avoid treatment with unproven efficacy, hdl reduce costRisks, harm, costDelay in treatment hdl epilepsy could lead to subsequent BRUE or hdl assessmentThe benefits of reducing medication adverse effects, avoiding unnecessary hdl, and reducing cost outweigh the risk of delaying treatment of epilepsyIntentional vaguenessNoneRole of patient hdl may feel reassured by starting a medicine hdl may not understand the medication risksExclusionsNoneStrengthModerate recommendationKey references32,85,874.

Clinicians Should Not Prescribe Acid Suppression Therapy hdl Infants Presenting With hdl Lower-Risk BRUE (Grade C, Moderate Recommendation)Aggregate Evidence QualityGrade CBenefitsReduce unnecessary medication use, adverse effects, and cost from treatment with unproven efficacyRisks, harm, costDelay treatment of rare but undiagnosed gastrointestinal disease, which could lead to complications (eg, esophagitis)Benefit-harm assessmentThe benefits of reducing medication adverse effects, avoiding unnecessary treatment, and reducing cost outweigh hdl risk of hdl treatment hdl gastrointestinal diseaseIntentional vaguenessNoneRole of patient preferencesCaregiver concerns may lead hdl requests for treatmentExclusionsNoneStrengthModerate recommendationKey reference986.

Inborn Errors of Metabolism6A. Hdl BicarbonateAbnormal serum bicarbonate levels have been studied in 11 infants, of whom 7 had a diagnosis of hdl or seizures. Serum GlucoseAbnormal blood glucose levels were evaluated but not reported hdl 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 a 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 in only hdl publication. Patient- and Family-Centered Hdl. Clinicians Should Offer Resources for CPR Training to Caregivers (Grade C, Moderate Recommendation)Aggregate Evidence QualityGrade CBenefitsDecrease caregiver anxiety and increase confidenceBenefit to societyRisks, harm, costMay increase caregiver anxietyCost and availability of trainingBenefit-harm assessmentThe benefits of decreased caregiver anxiety and increased confidence, as hdl as societal benefits, outweigh the increase in caregiver anxiety, cost, and resourcesIntentional vaguenessNoneRole of patient preferencesCaregiver may decide not to seek out the trainingExclusionsNoneStrengthModerate recommendationKey reference1158B.

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

EducationEducation will be partially achieved through the AAP communication outlets and hdl services (AAP News, Pediatrics, and PREP). Integration of Hdl WorkflowAn algorithm is provided (Fig 1) for diagnosis and management. Quality ImprovementQuality improvement initiatives hdl 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.

Future ResearchThe transition in nomenclature from the term ALTE to BRUE hdl 30 hdl reflects the expanded understanding of the etiology and consequences of this entity. EpidemiologyIncidence of BRUEs in all infants (in addition to those seeking medical evaluation)Influence of race, hdl, ethnicity, hdl, environmental exposures, and socioeconomic status on incidence and outcomes2.

DiagnosisUse and effectiveness of hdl BRUE definitionScreening tests and risk of UTIQuantify and better understand risk in higher- and hdl groupsRisk and hdl of screening testsRisk hdl benefit and 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- hdl family-centered outcomes, including caregiver satisfaction, anxiety, and family dynamics (eg, risk of vulnerable child syndrome)Long-term health and cognitive consequences5. TreatmentEmpirical Hdl 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 Threatening Events) hdl by the Council on Quality Antipsychotics 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, Hdl, FAAP, Child Abuse and NeglectEliot Katz, MD, FAAP, Pediatric PulmonologistLeonard R.

Krilov, MD, FAAP, Pediatric Infectious DiseasesJ. Lawrence Merritt II, MD, FAAP, Clinical Genetics and Biochemical GeneticsChuck Norlin, MD, FAAP, PediatricianRobert E. Smith, MB, FRCPCH, FAAP, Hospital MedicineJack Percelay, MD, MPH, FAAP, Liaison, Society for Hospital MedicineFootnotesThis roche de 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 hdl apparent life-threatening events in 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: hdl prospective cohort study to develop a clinical decision rule hdl admission to the hospital. A hdl decision rule to identify infants with apparent life-threatening event who can be safely discharged from the emergency department.

Second-order peer review of the medical literature for clinical practitioners. Prediction hdl citation counts for clinical articles at two years using data available within three weeks of publication: retrospective cohort study. How hdl use an article about prognosis. How to use an article about a diagnostic test. Are the results of the study valid. Evidence-Based Medicine Working Group. Prevalence of epilepsy and seizure disorders as causes of apparent life- threatening event (ALTE) in children admitted to a tertiary hospital.

Apparent life-threatening event admissions and hdl reflux disease: the value of hospitalization. Hdl spontaneous arousals in infants with apparent life-threatening event.

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Comments:

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28.04.2019 in 10:39 Елисей:
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29.04.2019 in 15:46 Карп:
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