The role of complementary examinations and home monitoring in patients at risk from apparent life threatening event, apneas and sudden infant death syndrome

array:24 ["pii" => "S2341287915001386" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.07.004" "estado" => "S300" "fechaPublicacion" => "2015-08-01" "aid" => "1774" "copyright" => "Asociación Española de Pediatría" "copyrightAnyo" => "2014" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2015;83:104-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1836 "formatos" => array:3 [ "EPUB" => 147 "HTML" => 1209 "PDF" => 480 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1695403314005335" "issn" => "16954033" "doi" => "10.1016/j.anpedi.2014.11.010" "estado" => "S300" "fechaPublicacion" => "2015-08-01" "aid" => "1774" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2015;83:104-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3194 "formatos" => array:3 [ "EPUB" => 142 "HTML" => 2363 "PDF" => 689 ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "ORIGINAL" "titulo" => "Papel de las exploraciones complementarias y de la monitorización domiciliaria en los pacientes de riesgo de episodio aparentemente letal, apneas y síndrome de muerte súbita del lactante" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "104" "paginaFinal" => "108" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "The role of complementary examinations and home monitoring in patients at risk from apparent life threatening event, apneas and sudden infant death syndrome" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Martínez Monseny, S. Bobillo Pérez, A. Martínez Planas, J.J. García García" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Martínez Monseny" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Bobillo Pérez" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Martínez Planas" ] 3 => array:2 [ "nombre" => "J.J." "apellidos" => "García García" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341287915001386" "doi" => "10.1016/j.anpede.2015.07.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001386?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403314005335?idApp=UINPBA00005H" "url" => "/16954033/0000008300000002/v2_201508010208/S1695403314005335/v2_201508010208/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2341287914001203" "issn" => "23412879" "doi" => "10.1016/j.anpede.2014.11.001" "estado" => "S300" "fechaPublicacion" => "2015-08-01" "aid" => "1772" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2015;83:109-16" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2700 "formatos" => array:3 [ "EPUB" => 139 "HTML" => 2078 "PDF" => 483 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Concordance between a head circumference growth function and intellectual disability in relation with the cause of microcephaly" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "109" "paginaFinal" => "116" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Concordancia entre una funcion de crecimiento del perimetro cefalico y la discapacidad intelectual en relacion con la etiologia de la microcefalia" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1032 "Ancho" => 1366 "Tamanyo" => 45211 ] ] "descripcion" => array:1 [ "en" => "Box plot of standardized HC Catch-up by neurological outcome. The median and the mean are depicted within the boxes as solid and dashed lines, respectively. Non disabled group: n=34, mean=0.45, standard deviation=0.64, median=0, IQR=0.88. Disabled group: n=102, mean=0.21, standard deviation=0.56, median=0, IQR=0. Wilcoxon rank-sum test: P<0.05." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Coronado, A. Macaya, J. Giraldo, M. Roig-Quilis" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Coronado" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Macaya" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Giraldo" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Roig-Quilis" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403314005311" "doi" => "10.1016/j.anpedi.2014.10.030" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403314005311?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287914001203?idApp=UINPBA00005H" "url" => "/23412879/0000008300000002/v1_201508150053/S2341287914001203/v1_201508150053/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S234128791400129X" "issn" => "23412879" "doi" => "10.1016/j.anpede.2014.10.003" "estado" => "S300" "fechaPublicacion" => "2015-08-01" "aid" => "1778" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2015;83:94-103" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 6521 "formatos" => array:3 [ "EPUB" => 299 "HTML" => 5259 "PDF" => 963 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Validation of a Spanish version of the childhood asthma control test (SC-ACT) for use in Spain" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "94" "paginaFinal" => "103" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Validación de la versión en español de la prueba de control del asma infantil (sc-act) para su uso en españa" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 777 "Ancho" => 2226 "Tamanyo" => 86747 ] ] "descripcion" => array:1 [ "en" => "Study design." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E.G. Pérez-Yarza, J.A. Castro-Rodriguez, J.R. Villa Asensi, J. Garde Garde, F.J. Hidalgo Bermejo" "autores" => array:6 [ 0 => array:2 [ "nombre" => "E.G." "apellidos" => "Pérez-Yarza" ] 1 => array:2 [ "nombre" => "J.A." "apellidos" => "Castro-Rodriguez" ] 2 => array:2 [ "nombre" => "J.R." "apellidos" => "Villa Asensi" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Garde Garde" ] 4 => array:2 [ "nombre" => "F.J." "apellidos" => "Hidalgo Bermejo" ] 5 => array:1 [ "colaborador" => "on behalf of the VESCASI Group" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403314005414" "doi" => "10.1016/j.anpedi.2014.10.031" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403314005414?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234128791400129X?idApp=UINPBA00005H" "url" => "/23412879/0000008300000002/v1_201508150053/S234128791400129X/v1_201508150053/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "The role of complementary examinations and home monitoring in patients at risk from apparent life threatening event, apneas and sudden infant death syndrome" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "104" "paginaFinal" => "108" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Martínez Monseny, S. Bobillo Pérez, A. Martínez Planas, J.J. García García" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Martínez Monseny" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Bobillo Pérez" ] 2 => array:4 [ "nombre" => "A." "apellidos" => "Martínez Planas" "email" => array:1 [ 0 => "amartinez@hsjdbcn.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 3 => array:2 [ "nombre" => "J.J." "apellidos" => "García García" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Papel de las exploraciones complementarias y de la monitorización domiciliaria en los pacientes de riesgo de episodio aparentemente letal, apneas y síndrome de muerte súbita del lactante" ] ] "textoCompleto" => "IntroductionApnoea monitors are devices designed to detect changes in heart rate and breathing effort associated with apnoea, and not to diagnose respiratory abnormalities associated with sleep in children.<a class="elsevierStyleCrossRef" href="#bib0085">1</a>Home apnoea monitors started to be used over thirty years ago, when it was hypothesised that prolonged apnoea may be the cause of sudden infant death syndrome (SIDS). They were designed to try to prevent death in infants by detecting episodes of central apnoea or bradycardia and alerting the parents so they could intervene before the event turned fatal.Subsequently, several studies have concluded that apnoea is not associated with SIDS and that the use of monitors will not prevent sudden death.<a class="elsevierStyleCrossRef" href="#bib0090">2</a>The fear of sudden infant death leads parents and clinicians to monitor at-risk infants for their protection, with the regrettable consequence that this provides a false sense of security when in fact monitoring devices are designed to detect a limited range of events.In our hospital, we started following up the use of apnoea monitors since 1997, at first in the context of preventing sudden death, and later including other indications for monitoring.The aim of our study was to describe the type of patients that are monitored, for how long, and the outcomes of these patients.Materials and methodsWe conducted a retrospective descriptive study of patients subject to home cardiorespiratory monitoring followed up between October 2008 and September 2012 at the outpatient clinic of a tertiary children's and maternity hospital.We selected the patients by the retrospective review of the electronic or paper medical records of all patients with an initial presenting complaint or a final diagnosis related to apnoea. From this set, we selected the patients with home apnoea monitors that were followed up in the outpatient clinic, and we collected data for epidemiological, clinical and management variables.Definitions<a class="elsevierStyleCrossRef" href="#bib0095">3</a>Apnoea: unexplained episode of cessation of airflow lasting 20s or longer, or of shorter duration if accompanied by bradycardia, cyanosis, pallor or severe hypotonia.Periodic breathing: breathing pattern with pauses lasting between 3 and 20s alternating with periods of normal breathing.Apparent life-threatening event (ALTE): acute event that is frightening to the observer consisting of some combination of apnoea of 20s of duration or longer, change in colour, and change in muscle tone, and requiring vigorous stimulation or resuscitation.SIDS: sudden death that is unexplained by history and for which the post-mortem examination fails to demonstrate the cause of death.The patients that were monitored due to apnoea of prematurity were those referred from the neonatal unit, and the patients included in the study for a history of ALTE were those with documented pathological events detected by monitoring during the observation period in the inpatient ward.We entered and processed the collected data in a Microsoft Access relational database (Microsoft Corporation, Redmond, United States).We performed the statistical analysis with the SPSS 20.0 software (SPSS Inc., Chicago, United States). Most variables were dichotomous and nominal, and were expressed as percentages, absolute frequencies, means with their standard deviations (SD) and medians with their interquartile range (IQR).We compared qualitative variables between groups by means of contingency tables, using the chi square test. We compared quantitative variables with the parametric Student's t test for independent samples.ResultsThe duration of followup in our study was 47 months, from October 2008 through September 2012. We included a total of 88 patients, 57.9% of whom were male, with a median age of 15.5 days at the start of monitoring (IQR, 2–54.2 days), and a median duration of monitoring of 4.7 months (IQR, 2.4–8.1 months).The indication for monitoring was a family history of sudden death in 20.5% of the patients, a previous ALTE in 20.5%, apnoea of prematurity in 25.0%, and choking in 14.8%. Other reasons accounted for the monitoring of 19.2% of the patients (apnoea/hypopnoea, episodes of oxygen desaturation, and periodic breathing).We have described the results for each of the three follow-up groups: apnoea of prematurity, history of sudden death and ALTE, the latter of which included choking and other reasons for monitoring.In the 22 patients of the apnoea of prematurity follow-up group that had been referred by the neonatology unit (25.0%), the mean and standard deviation of the duration of monitoring were 5.6±3.1 months. Nineteen (86.4%) of these patients were treated with caffeine for a mean of 2.6±1.2 months due to recordings compatible with apnoea of prematurity and/or immature breathing. Among them, 68.2% were born at gestational ages ranging from 32.0 to 36+6 weeks, 18.2% at 28.0 to 31+6 weeks of gestational age (GA) and another 13.6% at less than 28 weeks of GA.Eighteen patients (50.0% of whom were male) were followed up due to a family history of sudden death for a median of 8.1 months (IQR, 3.5–11 months). Additional tests were performed in these patients: cardiovascular assessment in 15 children (83.3%), neuroimaging studies in 8 (44.4%) and metabolic screening in 4 (22.2%). The tests did not detect disease in any of the patients, although in one of them they detected episodes of apnoea accompanied by bradycardia that resolved spontaneously. One of the patients died of an accidental pulmonary aspiration four months after monitoring was discontinued.In the third group of patients (n=48) that included ALTE, choking and other reasons for monitoring, a cardiovascular assessment was performed in 85.4% of the patients, and five had abnormal results (3 cases of foramen ovale, 1 of inferior vena cava agenesis, and 1 of ventricular septal defect). A Holter electrocardiogram (ECG) was performed in 5 patients, with normal results in all. An upper gastrointestinal (UGI) with small bowel series was performed in 37.5% of patients and was abnormal in six (33.3%). Videofluoroscopy was requested for 6 patients and was abnormal in 2. Neuroimaging tests were done in 37 patients (77.1%) with abnormal findings in 4 (arachnoid cyst in 1, signs of hypoxia due to severe hypoxic-ischaemic encephalopathy in 2, delayed myelination in 1). An electroencephalogram (EEG) was performed in 16 children (33.3%), with abnormal findings in two. Polysomnography was done in 16 patients and was abnormal in four. Metabolic screening was done in 62.5% of patients and was normal in all. In 50.0% (24) of the patients in this group, no new events were detected during monitoring. The final diagnosis of the patients in whom new events were detected were gastroesophageal reflux disease (GERD) in nine, apnoea of prematurity in two, a neurological condition in three, and apnoeas that were self-limited and of unknown cause in ten. While only two patients were diagnosed with apnoea of prematurity, eight were given caffeine for a suspected breathing disorder related to immaturity, and while GERD was detected in 9 patients, 12 received treatment.<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises all the diagnostic tests performed in each group along with their results.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The results of the comparisons between groups were not statistically significant.DiscussionPneumograms are useful in the detection of pathological events associated with changes in heart rate and breathing effort. However, after decades of home monitoring, the controversy surrounding their efficacy has led to recommendations for their use to be restricted to selected circumstances. They must be used with caution for ruling out other diseases or as a safety system for other events that occur in sleep.<a class="elsevierStyleCrossRef" href="#bib0100">4</a>Home apnoea monitors started to be used over twenty-five years ago at a time when prolonged apnoea was proposed as the possible cause of sudden infant death syndrome (SIDS). The original intent of these monitors was to detect bradycardia or prolonged breathing pauses and to alert the parents in order to prevent fatal outcomes in children with known risk factors. Subsequently, several studies have concluded that prolonged apnoea is not associated with SIDS and that monitors cannot prevent sudden death.<a class="elsevierStyleCrossRefs" href="#bib0105">5,6</a> The factors with a demonstrated association with a higher risk of sudden death, on which there is consensus among health professionals worldwide and which can be prevented, are prone sleep and prenatal and postnatal maternal smoking.<a class="elsevierStyleCrossRefs" href="#bib0100">4,7</a>Epidemiologically, there has been no change in the incidence of SIDS in relation to the use of monitors in the past decades,<a class="elsevierStyleCrossRef" href="#bib0110">6</a> but in clinical practice it is often still challenging for clinicians to determine when monitoring should be prescribed, for how long, and how to follow up these patients. The study by Hunt et al.<a class="elsevierStyleCrossRef" href="#bib0120">8</a> proposed that subtle cardiorespiratory changes detectable by monitors may precede pathological events like extreme apnoeas or bradycardias by a few hours. However, the American Academy of Paediatrics and the Asociación Española de Pediatría<a class="elsevierStyleCrossRef" href="#bib0100">4</a> recommend against using home monitoring for the prevention of SIDS, although they accept its potential usefulness for the quick detection of central apnoea in certain situations and in specific diseases.The indications for cardiorespiratory monitoring in our hospital, which are similar to those applied in many other facilities and are to be considered according to some clinical guidelines,<a class="elsevierStyleCrossRef" href="#bib0095">3</a> are essentially a history of sudden death in a sibling, apnoea of prematurity, or ALTE. We did not investigate other respiratory diseases that require assisted mechanical ventilation in our study. Thus, this case series assesses the diagnostic tests performed in children monitored for each of these reasons, including cardiovascular assessment, UGI and small bowel series, videofluoroscopy, EEG, neuroimaging and metabolic screening.Among the children followed up for apnoea of prematurity in our series, most of those being monitored at home had gestational ages that ranged between 32 and 36+6 weeks. The 2001 review by Zhaoy et al.<a class="elsevierStyleCrossRef" href="#bib0125">9</a> noted that the incidence of apnoea of prematurity is inversely proportional to gestational age, and that it affects almost all newborns younger than 29 weeks. This discrepancy may be due to the fact that in extremely preterm newborns, apnoea resolves before requiring followup, as apnoea of prematurity is a maturational and self-limiting problem, although we must also take into account that there is a smaller proportion of extremely preterm newborns. Their review also suggested that most cases resolve by week 36 to 40 of postconceptional age, in contrast with other studies that extend this period to 43 weeks of postconceptional age.<a class="elsevierStyleCrossRef" href="#bib0090">2</a> However, the duration of monitoring in patients with a history of apnoea of prematurity was probably excessive in our study, as it was of 5.6 months.In children followed up due to the previous death by SIDS of a sibling, the results of all the diagnostic tests were normal, with cardiovascular assessment being the most frequent investigation (83.3%). The median duration of followup was 8.1 months, which was probably related to the degree of anxiety experienced by the parents, and in some cases it lasted a few more months. Several reviews suggest that the risk of SIDS decreases after 6 months<a class="elsevierStyleCrossRef" href="#bib0130">10</a> and after 9 months in severe cases, and it is recommended that monitoring is discontinued at least 2 months beyond the age of the previous infant death.<a class="elsevierStyleCrossRef" href="#bib0095">3</a> The fact that only one pathological event was detected should make us reconsider this approach.In the case review by Hally et al.,<a class="elsevierStyleCrossRef" href="#bib0135">11</a> 7% of the children that died of SIDS had a history of ALTE. While some mothers of children that died of SIDS reported a previous ALTE more frequently that mothers of control children, those cases constituted a small proportion of the total cases of SIDS. In our study, none of the children that were followed up experienced a new event, and none of them died.There is published evidence on risk factors for ALTE that are identified in the anamnesis and physical examination and that would make a patient a candidate for home apnoea monitoring.<a class="elsevierStyleCrossRef" href="#bib0140">12</a> The known risk factors include preterm birth, multiple previous ALTEs and suspected child abuse. The yield of diagnostic tests for ALTE as defined in 1987<a class="elsevierStyleCrossRef" href="#bib0095">3</a> is questionable, and an aetiological investigation should be performed before prescribing the use of an apnoea monitor to rule out diseases that are treatable and may have caused the event.<a class="elsevierStyleCrossRef" href="#bib0095">3</a> At present, there is no well-defined protocol for the management of infants that experience ALTEs, and more powerful studies are needed to establish it. As Weiss et al. suggest in their prospective 2010 study,<a class="elsevierStyleCrossRef" href="#bib0145">13</a> the yield of diagnostic tests following an ALTE is low overall, and it only increases when there is a high degree of suspicion. Screening tests for gastroesophageal reflux, meningitis, bacteraemia or seizures are low yield in infants without historical risk factors or suggestive physical examination findings.<a class="elsevierStyleCrossRef" href="#bib0140">12</a> In our case series, EEG was performed in 33.3% of patients in the ALTE group, and it was only abnormal in two. The study we just mentioned reported a 4.5% yield for this test, in contrast with other studies that support the inclusion of EEG as a first-line test in cases of ALTE based on the fact that 11% of these patients are eventually diagnosed with seizures.<a class="elsevierStyleCrossRef" href="#bib0150">14</a> In our series, abnormal tracings were found in 4.2% of the ALTE patients, although some of these patients had additional signs and symptoms that suggested the presence of an underlying disease.Another example is the cardiovascular assessment. There is evidence that highlights the role of ECG as a potentially useful tool in the diagnosis of ALTE caused by changes in heart rate.<a class="elsevierStyleCrossRef" href="#bib0155">15</a> In our study, we found that ECG had been performed in 85.4% of patients that had experienced ALTEs, and the results of 12.2% of the tests had been abnormal. However, the echocardiogram findings did not explain the clinical features of the ALTE.As for neuroimaging as the gold standard for testing, the study by Weiss et al.<a class="elsevierStyleCrossRef" href="#bib0145">13</a> mentioned above advocated for reserving these methods for cases in which there is a strong clinical suspicion of neurological causes. In our case series, it was performed in 77.1% of the patients, and it was abnormal in four cases in which there was at least one concurrent abnormal finding, so its use for screening could be considered on a case-by-case basis.On the other hand, metabolic screening is included in the basic investigation of ALTEs in many studies.<a class="elsevierStyleCrossRef" href="#bib0150">14</a> In our series, it was performed in 62.5% of patients in the ALTE group and 22.2% of patients in the SIDS history group, and it was negative in all cases. While there are references that advocate for performing the screening because it is an innocuous and affordable test,<a class="elsevierStyleCrossRefs" href="#bib0130">10,14,16</a> its routine implementation is questionable based on the results of our study.Most of the diagnostic tests performed in our study were negative, and the few that had abnormal results usually did not suffice to determine the cause of apnoea. Thus, the most suitable approach may be to perform specific diagnostic tests based on the individual clinical context, as opposed to establishing a series of tests to be performed in all of these patients.The limitations of our study are its retrospective design, with the disadvantages that it carries, and that the sample consisted of children monitored at home, leaving out all cases of children that had an ALTE that was evaluated and did not require subsequent monitoring.In conclusion, suspected apnoea in infants is a presenting complaint that elicits great concern both in the family and the paediatrician, and the indication of apnoea monitoring is a subject of controversy. We know that it is useful in the detection of changes in heart rate and breathing effort, but its use must be restricted to selected circumstances and there must be an adequate followup of the patients, as there is a tendency to overuse it. The indication of monitoring in subsequent siblings of SIDS victims should be reviewed, the known risk factors established for ALTE should be evaluated, and limits should be set for the duration of its use in patients with apnoea of prematurity. It is also important to avoid the abuse of additional diagnostic tests and unnecessary treatments, and that further research of a greater scope be conducted to study the indications for testing, the duration of treatment and monitoring, and the followup of patients with risk factors.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres541320" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Material and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec560847" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres541319" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Materiales y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec560846" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Definitions" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-05-27" "fechaAceptado" => "2014-11-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec560847" "palabras" => array:4 [ 0 => "Home monitor" 1 => "Sudden infant death syndrome" 2 => "Apparent life-threatening events" 3 => "Apnea of prematurity" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec560846" "palabras" => array:4 [ 0 => "Monitor de apneas domiciliario" 1 => "Síndrome de muerte súbita del lactante" 2 => "Episodio aparentemente letal" 3 => "Apnea de la prematuridad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionHome apnea monitors detect abnormalities in cardiac and respiratory frequency, but their use in the diagnosis of respiratory-related sleep disturbances in children has not been demonstrated, as was originally thought. ObjectiveTo describe the type of patients being monitored, for how long and their outcome. Material and methodsA retrospective descriptive study was conducted on patients with controlled home cardiorespiratory monitoring from October 2008 to September 2012 in the Outpatient department of a Maternity tertiary hospital. ResultsDuring the study period 88 patients were included, 58% of them were male, with a median age of 15.5 days, and followed up for a period of 4.7 months. The reason for monitoring was due to a history of sudden death without finding underlying pathology in 20.5%, 25% due to apnea of prematurity, 20.5% due to apparent life-threatening event, and 14.8% due to choking. Other causes accounted for 19.3% (apnea/hypopnea, desaturation and periodic breathing). Of these last three groups, pathological events were observed in 50% of them: reflux disease (9), apnea of prematurity (2), neurological causes (3), and apnea of unknown cause (10). ConclusionsSuspected infant apnea is a cause for consultation that creates a great deal of concern to the family and the paediatrician. Home monitoring is useful in detecting changes in cardiac and respiratory frequency, but is necessary to limit its indications and ensure proper monitoring of these patients, avoiding the abuse of other tests or treatments." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Material and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLos monitores de apneas detectan anomalías en la frecuencia cardíaca y respiratoria, sin utilidad demostrada para el diagnóstico de alteraciones respiratorias relacionadas con el sueño en los niños como se pensaba en su origen. ObjetivoDescribir el tipo de pacientes que se monitorizan, durante cuánto tiempo y la evolución de los mismos. Materiales y métodosEstudio descriptivo retrospectivo de los pacientes con monitorización cardiorrespiratoria domiciliaria controlados, desde octubre del 2008 hasta septiembre del 2012, en consultas externas de un hospital materno-infantil de tercer nivel. ResultadosDurante el periodo de estudio fueron incluidos 88 pacientes, el 58% de ellos de sexo masculino, con una mediana de edad de 15,5 días y durante un periodo de 4,7 meses. El motivo de monitorización fue en un 20,5% por antecedente de muerte súbita, sin encontrar patología subyacente; un 25% por apnea de la prematuridad; un 20,5% por episodio aparentemente letal, y un 14.8% por atragantamiento. Otras causas suponen el 19,3% (apnea/hipopnea, desaturaciones y respiración periódica). De estos 3 últimos grupos, en el 50% se registraron eventos patológicos: reflujo patológico (9), apneas de la prematuridad (2), causa neurológica (3) y apneas de causa desconocida (10). ConclusionesLa sospecha de apnea del lactante es un motivo de consulta que crea gran preocupación tanto a la familia como al pediatra. La monitorización domiciliaria es útil en la detección de alteraciones en la frecuencia cardíaca y respiratoria pero es necesario limitar sus indicaciones y realizar un buen seguimiento de estos pacientes, evitando el abuso de otras pruebas complementarias o tratamientos." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Materiales y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Martínez Monseny A, Bobillo Pérez S, Martínez Planas A, García García JJ. Papel de las exploraciones complementarias y de la monitorización domiciliaria en los pacientes de riesgo de episodio aparentemente letal, apneas y síndrome de muerte súbita del lactante. An Pediatr (Barc). 2015;83:104–108." ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Apnoea of prematurity (n=22)</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">SIDS history (n=18)</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ALTE/other (n=48)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Performed</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Performed</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Performed</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Abnormal</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Performed</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Abnormal</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">ECG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Echocardiography \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">UGI and small intestine series \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Videofluoroscopy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Neuroimaging \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">EEG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Polysomnography \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Metabolic screening \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab869289.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Tests performed in the study by reason for followup." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0085" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pediatric home apnea monitors coding, billing, and updated prescribing information for practice management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.C. Halbower" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.08-0538" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2008" "volumen" => "134" "paginaInicial" => "425" "paginaFinal" => "429" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18682461" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0090" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Apnea, sudden infant death syndrome and home monitoring" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Committe on Fetus and Newborn" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Pediatrics" "fecha" => "2003" "volumen" => "11" "paginaInicial" => "914" "paginaFinal" => "917" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0095" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Consensus development conference on infantile apnea and home monitoring. National Institutes of Health" ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "1987" "volumen" => "79" "paginaInicial" => "292" "paginaFinal" => "299" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3808807" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0100" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Libro blanco de la muerte súbita del lactante (SMSL)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Grupo de Trabajo para el Estudio y Prevención de la Muerte Súbita Infantil de la Asociación Española de Pediatría" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "3rd ed." "fecha" => "2013" "editorial" => "Editorial Ergon" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0105" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Why do ALTE infants not die in SIDS?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Edner" 1 => "M. Wennborg" 2 => "B. Alm" 3 => "H. Lagercrantz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Paediatr" "fecha" => "2007" "volumen" => "96" "paginaInicial" => "191" "paginaFinal" => "194" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17429903" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0110" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "SIDS ALTE, apnea, and the use of home monitors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.A. Farrel" 1 => "G.M. Weiner" 2 => "J.A. Lemons" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatr Rev" "fecha" => "2002" "volumen" => "23" "paginaInicial" => "3" "paginaFinal" => "10" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11773587" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0115" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factor changes for sudden infant death syndrome after initiation of Back-to-Sleep campaign" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F.L. Trachtenberg" 1 => "E.A. Haas" 2 => "H.C. Kinney" 3 => "C. Stanley" 4 => "H.F. Krous" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2011-1419" "Revista" => array:7 [ "tituloSerie" => "Pediatrics" "fecha" => "2012" "volumen" => "129" "paginaInicial" => "630" "paginaFinal" => "638" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22451703" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002937810000748" "estado" => "S300" "issn" => "00029378" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0120" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Precursors of cardiorespiratory events in infants detected by home memory monitor" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.E. Hunt" 1 => "M.J. Corwin" 2 => "G. Lister" 3 => "D.E. Weese-Mayer" 4 => "S.L. Davidson-Ward" 5 => "L.R. Tinsley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ppul.20745" "Revista" => array:5 [ "tituloSerie" => "Pediatr Pulmonol" "fecha" => "2008" "volumen" => "43" "paginaInicial" => "87" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18041078" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0125" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Apnea of prematurity: from cause to treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Zhao" 1 => "F. Gonzalez" 2 => "D. Mu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Eur J Pediatr" "fecha" => "2011" "volumen" => "170" "paginaInicial" => "1097" "paginaFinal" => "1105" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0130" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluación y seguimiento de lactantes que sufrieron un episodio aparentemente letal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Leal" 1 => "M. García" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr Contin" "fecha" => "2010" "volumen" => "8" "paginaInicial" => "98" "paginaFinal" => "103" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0135" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation and management of apparent life-threatening events in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K.L. Hall" 1 => "B. Zalman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am Fam Physician" "fecha" => "2005" "volumen" => "71" "paginaInicial" => "2301" "paginaFinal" => "2308" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15999867" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0140" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of apparent life-threatening events in infants: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.S. Tieder" 1 => "R.L. Altman" 2 => "J.L. Bonkowsky" 3 => "D.A. Brand" 4 => "I. Claudius" 5 => "D.J. Cunningham" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jpeds.2012.12.086" "Revista" => array:5 [ "tituloSerie" => "J Pediatr" "fecha" => "2013" "volumen" => "163" "paginaInicial" => "94" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23415612" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0145" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How to evaluate the child presenting with an apparent life-threatening event" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Weiss" 1 => "A. Fattal-Valexski" 2 => "S. Reif" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "IMAJ" "fecha" => "2010" "volumen" => "12" "paginaInicial" => "154" "paginaFinal" => "157" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20684179" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0150" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Causes of apparent life threatening events in infants: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.C. McGovern" 1 => "M.B. Smith" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/adc.2003.031740" "Revista" => array:6 [ "tituloSerie" => "Arch Dis Child" "fecha" => "2004" "volumen" => "89" "paginaInicial" => "1043" "paginaFinal" => "1048" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15499062" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0155" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of ECG use in infants with apparent life-threatening events: a multicentre database study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.D. Elias" 1 => "V.R. Iyer" 2 => "M.S. Cohen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PEC.0000000000000059" "Revista" => array:7 [ "tituloSerie" => "Pediatr Emerg Care" "fecha" => "2014" "volumen" => "30" "paginaInicial" => "1" "paginaFinal" => "4" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24365725" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002937810008604" "estado" => "S300" "issn" => "00029378" ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0160" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Apparent life-threatening events: an update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L.Y. Fu" 1 => "R.Y. Moon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/pir.33-8-361" "Revista" => array:6 [ "tituloSerie" => "Pediatr Rev" "fecha" => "2012" "volumen" => "33" "paginaInicial" => "361" "paginaFinal" => "369" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22855928" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008300000002/v1_201508150053/S2341287915001386/v1_201508150053/en/main.assets" "Apartado" => array:4 [ "identificador" => "26005" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008300000002/v1_201508150053/S2341287915001386/v1_201508150053/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001386?idApp=UINPBA00005H"]

Statistics

Original Article

The role of complementary examinations and home monitoring in patients at risk from apparent life threatening event, apneas and sudden infant death syndrome

Papel de las exploraciones complementarias y de la monitorización domiciliaria en los pacientes de riesgo de episodio aparentemente letal, apneas y síndrome de muerte súbita del lactante

A. Martínez Monseny, S. Bobillo Pérez, A. Martínez Planas

Corresponding author

amartinez@hsjdbcn.org

Corresponding author.

, J.J. García García

Servicio de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain

Read

5339

Times
was read the article

2199

Total PDF

3140

Total HTML

Share statistics

 array:24 [
  "pii" => "S2341287915001386"
  "issn" => "23412879"
  "doi" => "10.1016/j.anpede.2015.07.004"
  "estado" => "S300"
  "fechaPublicacion" => "2015-08-01"
  "aid" => "1774"
  "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
  "copyrightAnyo" => "2014"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "An Pediatr &#40;Barc&#41;. 2015;83:104-8"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 1836
    "formatos" => array:3 [
      "EPUB" => 147
      "HTML" => 1209
      "PDF" => 480
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1695403314005335"
      "issn" => "16954033"
      "doi" => "10.1016/j.anpedi.2014.11.010"
      "estado" => "S300"
      "fechaPublicacion" => "2015-08-01"
      "aid" => "1774"
      "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "An Pediatr &#40;Barc&#41;. 2015;83:104-8"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 3194
        "formatos" => array:3 [
          "EPUB" => 142
          "HTML" => 2363
          "PDF" => 689
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>"
        "titulo" => "Papel de las exploraciones complementarias y de la monitorizaci&#243;n domiciliaria en los pacientes de riesgo de episodio aparentemente letal&#44; apneas y s&#237;ndrome de muerte s&#250;bita del lactante"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "104"
            "paginaFinal" => "108"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "The role of complementary examinations and home monitoring in patients at risk from apparent life threatening event&#44; apneas and sudden infant death syndrome"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "A&#46; Mart&#237;nez Monseny, S&#46; Bobillo P&#233;rez, A&#46; Mart&#237;nez Planas, J&#46;J&#46; Garc&#237;a Garc&#237;a"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Mart&#237;nez Monseny"
              ]
              1 => array:2 [
                "nombre" => "S&#46;"
                "apellidos" => "Bobillo P&#233;rez"
              ]
              2 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Mart&#237;nez Planas"
              ]
              3 => array:2 [
                "nombre" => "J&#46;J&#46;"
                "apellidos" => "Garc&#237;a Garc&#237;a"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2341287915001386"
          "doi" => "10.1016/j.anpede.2015.07.004"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001386?idApp=UINPBA00005H"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403314005335?idApp=UINPBA00005H"
      "url" => "/16954033/0000008300000002/v2_201508010208/S1695403314005335/v2_201508010208/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S2341287914001203"
    "issn" => "23412879"
    "doi" => "10.1016/j.anpede.2014.11.001"
    "estado" => "S300"
    "fechaPublicacion" => "2015-08-01"
    "aid" => "1772"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "An Pediatr &#40;Barc&#41;. 2015;83:109-16"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2700
      "formatos" => array:3 [
        "EPUB" => 139
        "HTML" => 2078
        "PDF" => 483
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Concordance between a head circumference growth function and intellectual disability in relation with the cause of microcephaly"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "109"
          "paginaFinal" => "116"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Concordancia entre una funcion de crecimiento del perimetro cefalico y la discapacidad intelectual en relacion con la etiologia de la microcefalia"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 1032
              "Ancho" => 1366
              "Tamanyo" => 45211
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Box plot of standardized HC Catch-up by neurological outcome&#46; The median and the mean are depicted within the boxes as solid and dashed lines&#44; respectively&#46; Non disabled group&#58; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&#44; mean<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;45&#44; standard deviation<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;64&#44; median<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44; IQR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;88&#46; Disabled group&#58; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>102&#44; mean<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;21&#44; standard deviation<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;56&#44; median<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44; IQR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46; Wilcoxon rank-sum test&#58; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "R&#46; Coronado, A&#46; Macaya, J&#46; Giraldo, M&#46; Roig-Quilis"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Coronado"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Macaya"
            ]
            2 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Giraldo"
            ]
            3 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Roig-Quilis"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1695403314005311"
        "doi" => "10.1016/j.anpedi.2014.10.030"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403314005311?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287914001203?idApp=UINPBA00005H"
    "url" => "/23412879/0000008300000002/v1_201508150053/S2341287914001203/v1_201508150053/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S234128791400129X"
    "issn" => "23412879"
    "doi" => "10.1016/j.anpede.2014.10.003"
    "estado" => "S300"
    "fechaPublicacion" => "2015-08-01"
    "aid" => "1778"
    "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "An Pediatr &#40;Barc&#41;. 2015;83:94-103"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 6521
      "formatos" => array:3 [
        "EPUB" => 299
        "HTML" => 5259
        "PDF" => 963
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Validation of a Spanish version of the childhood asthma control test &#40;SC-ACT&#41; for use in Spain"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "94"
          "paginaFinal" => "103"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Validaci&#243;n de la versi&#243;n en espa&#241;ol de la prueba de control del asma infantil &#40;sc-act&#41; para su uso en espa&#241;a"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 777
              "Ancho" => 2226
              "Tamanyo" => 86747
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Study design&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "E&#46;G&#46; P&#233;rez-Yarza, J&#46;A&#46; Castro-Rodriguez, J&#46;R&#46; Villa Asensi, J&#46; Garde Garde, F&#46;J&#46; Hidalgo Bermejo"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "E&#46;G&#46;"
              "apellidos" => "P&#233;rez-Yarza"
            ]
            1 => array:2 [
              "nombre" => "J&#46;A&#46;"
              "apellidos" => "Castro-Rodriguez"
            ]
            2 => array:2 [
              "nombre" => "J&#46;R&#46;"
              "apellidos" => "Villa Asensi"
            ]
            3 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Garde Garde"
            ]
            4 => array:2 [
              "nombre" => "F&#46;J&#46;"
              "apellidos" => "Hidalgo Bermejo"
            ]
            5 => array:1 [
              "colaborador" => "on behalf of the VESCASI Group"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1695403314005414"
        "doi" => "10.1016/j.anpedi.2014.10.031"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403314005414?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234128791400129X?idApp=UINPBA00005H"
    "url" => "/23412879/0000008300000002/v1_201508150053/S234128791400129X/v1_201508150053/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "The role of complementary examinations and home monitoring in patients at risk from apparent life threatening event&#44; apneas and sudden infant death syndrome"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "104"
        "paginaFinal" => "108"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "A&#46; Mart&#237;nez Monseny, S&#46; Bobillo P&#233;rez, A&#46; Mart&#237;nez Planas, J&#46;J&#46; Garc&#237;a Garc&#237;a"
        "autores" => array:4 [
          0 => array:2 [
            "nombre" => "A&#46;"
            "apellidos" => "Mart&#237;nez Monseny"
          ]
          1 => array:2 [
            "nombre" => "S&#46;"
            "apellidos" => "Bobillo P&#233;rez"
          ]
          2 => array:4 [
            "nombre" => "A&#46;"
            "apellidos" => "Mart&#237;nez Planas"
            "email" => array:1 [
              0 => "amartinez&#64;hsjdbcn&#46;org"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          3 => array:2 [
            "nombre" => "J&#46;J&#46;"
            "apellidos" => "Garc&#237;a Garc&#237;a"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Pediatr&#237;a&#44; Hospital Sant Joan de D&#233;u&#44; Esplugues de Llobregat&#44; Barcelona&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Papel de las exploraciones complementarias y de la monitorizaci&#243;n domiciliaria en los pacientes de riesgo de episodio aparentemente letal&#44; apneas y s&#237;ndrome de muerte s&#250;bita del lactante"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Apnoea monitors are devices designed to detect changes in heart rate and breathing effort associated with apnoea&#44; and not to diagnose respiratory abnormalities associated with sleep in children&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Home apnoea monitors started to be used over thirty years ago&#44; when it was hypothesised that prolonged apnoea may be the cause of sudden infant death syndrome &#40;SIDS&#41;&#46; They were designed to try to prevent death in infants by detecting episodes of central apnoea or bradycardia and alerting the parents so they could intervene before the event turned fatal&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Subsequently&#44; several studies have concluded that apnoea is not associated with SIDS and that the use of monitors will not prevent sudden death&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The fear of sudden infant death leads parents and clinicians to monitor at-risk infants for their protection&#44; with the regrettable consequence that this provides a false sense of security when in fact monitoring devices are designed to detect a limited range of events&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In our hospital&#44; we started following up the use of apnoea monitors since 1997&#44; at first in the context of preventing sudden death&#44; and later including other indications for monitoring&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of our study was to describe the type of patients that are monitored&#44; for how long&#44; and the outcomes of these patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">We conducted a retrospective descriptive study of patients subject to home cardiorespiratory monitoring followed up between October 2008 and September 2012 at the outpatient clinic of a tertiary children&#39;s and maternity hospital&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We selected the patients by the retrospective review of the electronic or paper medical records of all patients with an initial presenting complaint or a final diagnosis related to apnoea&#46; From this set&#44; we selected the patients with home apnoea monitors that were followed up in the outpatient clinic&#44; and we collected data for epidemiological&#44; clinical and management variables&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Definitions<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a></span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Apnoea</span>&#58; unexplained episode of cessation of airflow lasting 20<span class="elsevierStyleHsp" style=""></span>s or longer&#44; or of shorter duration if accompanied by bradycardia&#44; cyanosis&#44; pallor or severe hypotonia&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Periodic breathing</span>&#58; breathing pattern with pauses lasting between 3 and 20<span class="elsevierStyleHsp" style=""></span>s alternating with periods of normal breathing&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Apparent life-threatening event</span> &#40;<span class="elsevierStyleItalic">ALTE</span>&#41;&#58; acute event that is frightening to the observer consisting of some combination of apnoea of 20<span class="elsevierStyleHsp" style=""></span>s of duration or longer&#44; change in colour&#44; and change in muscle tone&#44; and requiring vigorous stimulation or resuscitation&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">SIDS</span>&#58; sudden death that is unexplained by history and for which the post-mortem examination fails to demonstrate the cause of death&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The patients that were monitored due to apnoea of prematurity were those referred from the neonatal unit&#44; and the patients included in the study for a history of ALTE were those with documented pathological events detected by monitoring during the observation period in the inpatient ward&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">We entered and processed the collected data in a Microsoft Access relational database &#40;Microsoft Corporation&#44; Redmond&#44; United States&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">We performed the statistical analysis with the SPSS 20&#46;0 software &#40;SPSS Inc&#46;&#44; Chicago&#44; United States&#41;&#46; Most variables were dichotomous and nominal&#44; and were expressed as percentages&#44; absolute frequencies&#44; means with their standard deviations &#40;SD&#41; and medians with their interquartile range &#40;IQR&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">We compared qualitative variables between groups by means of contingency tables&#44; using the chi square test&#46; We compared quantitative variables with the parametric Student&#39;s <span class="elsevierStyleItalic">t</span> test for independent samples&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">The duration of followup in our study was 47 months&#44; from October 2008 through September 2012&#46; We included a total of 88 patients&#44; 57&#46;9&#37; of whom were male&#44; with a median age of 15&#46;5 days at the start of monitoring &#40;IQR&#44; 2&#8211;54&#46;2 days&#41;&#44; and a median duration of monitoring of 4&#46;7 months &#40;IQR&#44; 2&#46;4&#8211;8&#46;1 months&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The indication for monitoring was a family history of sudden death in 20&#46;5&#37; of the patients&#44; a previous ALTE in 20&#46;5&#37;&#44; apnoea of prematurity in 25&#46;0&#37;&#44; and choking in 14&#46;8&#37;&#46; Other reasons accounted for the monitoring of 19&#46;2&#37; of the patients &#40;apnoea&#47;hypopnoea&#44; episodes of oxygen desaturation&#44; and periodic breathing&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">We have described the results for each of the three follow-up groups&#58; apnoea of prematurity&#44; history of sudden death and ALTE&#44; the latter of which included choking and other reasons for monitoring&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In the 22 patients of the apnoea of prematurity follow-up group that had been referred by the neonatology unit &#40;25&#46;0&#37;&#41;&#44; the mean and standard deviation of the duration of monitoring were 5&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;1 months&#46; Nineteen &#40;86&#46;4&#37;&#41; of these patients were treated with caffeine for a mean of 2&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2 months due to recordings compatible with apnoea of prematurity and&#47;or immature breathing&#46; Among them&#44; 68&#46;2&#37; were born at gestational ages ranging from 32&#46;0 to 36<span class="elsevierStyleSup">&#43;6</span> weeks&#44; 18&#46;2&#37; at 28&#46;0 to 31<span class="elsevierStyleSup">&#43;6</span> weeks of gestational age &#40;GA&#41; and another 13&#46;6&#37; at less than 28 weeks of GA&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Eighteen patients &#40;50&#46;0&#37; of whom were male&#41; were followed up due to a family history of sudden death for a median of 8&#46;1 months &#40;IQR&#44; 3&#46;5&#8211;11 months&#41;&#46; Additional tests were performed in these patients&#58; cardiovascular assessment in 15 children &#40;83&#46;3&#37;&#41;&#44; neuroimaging studies in 8 &#40;44&#46;4&#37;&#41; and metabolic screening in 4 &#40;22&#46;2&#37;&#41;&#46; The tests did not detect disease in any of the patients&#44; although in one of them they detected episodes of apnoea accompanied by bradycardia that resolved spontaneously&#46; One of the patients died of an accidental pulmonary aspiration four months after monitoring was discontinued&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In the third group of patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>48&#41; that included ALTE&#44; choking and other reasons for monitoring&#44; a cardiovascular assessment was performed in 85&#46;4&#37; of the patients&#44; and five had abnormal results &#40;3 cases of foramen ovale&#44; 1 of inferior vena cava agenesis&#44; and 1 of ventricular septal defect&#41;&#46; A Holter electrocardiogram &#40;ECG&#41; was performed in 5 patients&#44; with normal results in all&#46; An upper gastrointestinal &#40;UGI&#41; with small bowel series was performed in 37&#46;5&#37; of patients and was abnormal in six &#40;33&#46;3&#37;&#41;&#46; Videofluoroscopy was requested for 6 patients and was abnormal in 2&#46; Neuroimaging tests were done in 37 patients &#40;77&#46;1&#37;&#41; with abnormal findings in 4 &#40;arachnoid cyst in 1&#44; signs of hypoxia due to severe hypoxic-ischaemic encephalopathy in 2&#44; delayed myelination in 1&#41;&#46; An electroencephalogram &#40;EEG&#41; was performed in 16 children &#40;33&#46;3&#37;&#41;&#44; with abnormal findings in two&#46; Polysomnography was done in 16 patients and was abnormal in four&#46; Metabolic screening was done in 62&#46;5&#37; of patients and was normal in all&#46; In 50&#46;0&#37; &#40;24&#41; of the patients in this group&#44; no new events were detected during monitoring&#46; The final diagnosis of the patients in whom new events were detected were gastroesophageal reflux disease &#40;GERD&#41; in nine&#44; apnoea of prematurity in two&#44; a neurological condition in three&#44; and apnoeas that were self-limited and of unknown cause in ten&#46; While only two patients were diagnosed with apnoea of prematurity&#44; eight were given caffeine for a suspected breathing disorder related to immaturity&#44; and while GERD was detected in 9 patients&#44; 12 received treatment&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises all the diagnostic tests performed in each group along with their results&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">The results of the comparisons between groups were not statistically significant&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">Pneumograms are useful in the detection of pathological events associated with changes in heart rate and breathing effort&#46; However&#44; after decades of home monitoring&#44; the controversy surrounding their efficacy has led to recommendations for their use to be restricted to selected circumstances&#46; They must be used with caution for ruling out other diseases or as a safety system for other events that occur in sleep&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">4</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Home apnoea monitors started to be used over twenty-five years ago at a time when prolonged apnoea was proposed as the possible cause of sudden infant death syndrome &#40;SIDS&#41;&#46; The original intent of these monitors was to detect bradycardia or prolonged breathing pauses and to alert the parents in order to prevent fatal outcomes in children with known risk factors&#46; Subsequently&#44; several studies have concluded that prolonged apnoea is not associated with SIDS and that monitors cannot prevent sudden death&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">5&#44;6</span></a> The factors with a demonstrated association with a higher risk of sudden death&#44; on which there is consensus among health professionals worldwide and which can be prevented&#44; are prone sleep and prenatal and postnatal maternal smoking&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">4&#44;7</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Epidemiologically&#44; there has been no change in the incidence of SIDS in relation to the use of monitors in the past decades&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">6</span></a> but in clinical practice it is often still challenging for clinicians to determine when monitoring should be prescribed&#44; for how long&#44; and how to follow up these patients&#46; The study by Hunt et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">8</span></a> proposed that subtle cardiorespiratory changes detectable by monitors may precede pathological events like extreme apnoeas or bradycardias by a few hours&#46; However&#44; the American Academy of Paediatrics and the Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">4</span></a> recommend against using home monitoring for the prevention of SIDS&#44; although they accept its potential usefulness for the quick detection of central apnoea in certain situations and in specific diseases&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The indications for cardiorespiratory monitoring in our hospital&#44; which are similar to those applied in many other facilities and are to be considered according to some clinical guidelines&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a> are essentially a history of sudden death in a sibling&#44; apnoea of prematurity&#44; or ALTE&#46; We did not investigate other respiratory diseases that require assisted mechanical ventilation in our study&#46; Thus&#44; this case series assesses the diagnostic tests performed in children monitored for each of these reasons&#44; including cardiovascular assessment&#44; UGI and small bowel series&#44; videofluoroscopy&#44; EEG&#44; neuroimaging and metabolic screening&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Among the children followed up for apnoea of prematurity in our series&#44; most of those being monitored at home had gestational ages that ranged between 32 and 36<span class="elsevierStyleSup">&#43;6</span> weeks&#46; The 2001 review by Zhaoy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a> noted that the incidence of apnoea of prematurity is inversely proportional to gestational age&#44; and that it affects almost all newborns younger than 29 weeks&#46; This discrepancy may be due to the fact that in extremely preterm newborns&#44; apnoea resolves before requiring followup&#44; as apnoea of prematurity is a maturational and self-limiting problem&#44; although we must also take into account that there is a smaller proportion of extremely preterm newborns&#46; Their review also suggested that most cases resolve by week 36 to 40 of postconceptional age&#44; in contrast with other studies that extend this period to 43 weeks of postconceptional age&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">2</span></a> However&#44; the duration of monitoring in patients with a history of apnoea of prematurity was probably excessive in our study&#44; as it was of 5&#46;6 months&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">In children followed up due to the previous death by SIDS of a sibling&#44; the results of all the diagnostic tests were normal&#44; with cardiovascular assessment being the most frequent investigation &#40;83&#46;3&#37;&#41;&#46; The median duration of followup was 8&#46;1 months&#44; which was probably related to the degree of anxiety experienced by the parents&#44; and in some cases it lasted a few more months&#46; Several reviews suggest that the risk of SIDS decreases after 6 months<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">10</span></a> and after 9 months in severe cases&#44; and it is recommended that monitoring is discontinued at least 2 months beyond the age of the previous infant death&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a> The fact that only one pathological event was detected should make us reconsider this approach&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In the case review by Hally et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a> 7&#37; of the children that died of SIDS had a history of ALTE&#46; While some mothers of children that died of SIDS reported a previous ALTE more frequently that mothers of control children&#44; those cases constituted a small proportion of the total cases of SIDS&#46; In our study&#44; none of the children that were followed up experienced a new event&#44; and none of them died&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">There is published evidence on risk factors for ALTE that are identified in the anamnesis and physical examination and that would make a patient a candidate for home apnoea monitoring&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a> The known risk factors include preterm birth&#44; multiple previous ALTEs and suspected child abuse&#46; The yield of diagnostic tests for ALTE as defined in 1987<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a> is questionable&#44; and an aetiological investigation should be performed before prescribing the use of an apnoea monitor to rule out diseases that are treatable and may have caused the event&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a> At present&#44; there is no well-defined protocol for the management of infants that experience ALTEs&#44; and more powerful studies are needed to establish it&#46; As Weiss et al&#46; suggest in their prospective 2010 study&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">13</span></a> the yield of diagnostic tests following an ALTE is low overall&#44; and it only increases when there is a high degree of suspicion&#46; Screening tests for gastroesophageal reflux&#44; meningitis&#44; bacteraemia or seizures are low yield in infants without historical risk factors or suggestive physical examination findings&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a> In our case series&#44; EEG was performed in 33&#46;3&#37; of patients in the ALTE group&#44; and it was only abnormal in two&#46; The study we just mentioned reported a 4&#46;5&#37; yield for this test&#44; in contrast with other studies that support the inclusion of EEG as a first-line test in cases of ALTE based on the fact that 11&#37; of these patients are eventually diagnosed with seizures&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a> In our series&#44; abnormal tracings were found in 4&#46;2&#37; of the ALTE patients&#44; although some of these patients had additional signs and symptoms that suggested the presence of an underlying disease&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Another example is the cardiovascular assessment&#46; There is evidence that highlights the role of ECG as a potentially useful tool in the diagnosis of ALTE caused by changes in heart rate&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a> In our study&#44; we found that ECG had been performed in 85&#46;4&#37; of patients that had experienced ALTEs&#44; and the results of 12&#46;2&#37; of the tests had been abnormal&#46; However&#44; the echocardiogram findings did not explain the clinical features of the ALTE&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">As for neuroimaging as the gold standard for testing&#44; the study by Weiss et al&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">13</span></a> mentioned above advocated for reserving these methods for cases in which there is a strong clinical suspicion of neurological causes&#46; In our case series&#44; it was performed in 77&#46;1&#37; of the patients&#44; and it was abnormal in four cases in which there was at least one concurrent abnormal finding&#44; so its use for screening could be considered on a case-by-case basis&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">On the other hand&#44; metabolic screening is included in the basic investigation of ALTEs in many studies&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a> In our series&#44; it was performed in 62&#46;5&#37; of patients in the ALTE group and 22&#46;2&#37; of patients in the SIDS history group&#44; and it was negative in all cases&#46; While there are references that advocate for performing the screening because it is an innocuous and affordable test&#44;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">10&#44;14&#44;16</span></a> its routine implementation is questionable based on the results of our study&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Most of the diagnostic tests performed in our study were negative&#44; and the few that had abnormal results usually did not suffice to determine the cause of apnoea&#46; Thus&#44; the most suitable approach may be to perform specific diagnostic tests based on the individual clinical context&#44; as opposed to establishing a series of tests to be performed in all of these patients&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">The limitations of our study are its retrospective design&#44; with the disadvantages that it carries&#44; and that the sample consisted of children monitored at home&#44; leaving out all cases of children that had an ALTE that was evaluated and did not require subsequent monitoring&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">In conclusion&#44; suspected apnoea in infants is a presenting complaint that elicits great concern both in the family and the paediatrician&#44; and the indication of apnoea monitoring is a subject of controversy&#46; We know that it is useful in the detection of changes in heart rate and breathing effort&#44; but its use must be restricted to selected circumstances and there must be an adequate followup of the patients&#44; as there is a tendency to overuse it&#46; The indication of monitoring in subsequent siblings of SIDS victims should be reviewed&#44; the known risk factors established for ALTE should be evaluated&#44; and limits should be set for the duration of its use in patients with apnoea of prematurity&#46; It is also important to avoid the abuse of additional diagnostic tests and unnecessary treatments&#44; and that further research of a greater scope be conducted to study the indications for testing&#44; the duration of treatment and monitoring&#44; and the followup of patients with risk factors&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:3 [
          "identificador" => "xres541320"
          "titulo" => "Abstract"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Objective"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Material and methods"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Results"
            ]
            4 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec560847"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres541319"
          "titulo" => "Resumen"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Introducci&#243;n"
            ]
            1 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Objetivo"
            ]
            2 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Materiales y m&#233;todos"
            ]
            3 => array:2 [
              "identificador" => "abst0045"
              "titulo" => "Resultados"
            ]
            4 => array:2 [
              "identificador" => "abst0050"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec560846"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Materials and methods"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Definitions"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflicts of interest"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-05-27"
    "fechaAceptado" => "2014-11-14"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec560847"
          "palabras" => array:4 [
            0 => "Home monitor"
            1 => "Sudden infant death syndrome"
            2 => "Apparent life-threatening events"
            3 => "Apnea of prematurity"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec560846"
          "palabras" => array:4 [
            0 => "Monitor de apneas domiciliario"
            1 => "S&#237;ndrome de muerte s&#250;bita del lactante"
            2 => "Episodio aparentemente letal"
            3 => "Apnea de la prematuridad"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Home apnea monitors detect abnormalities in cardiac and respiratory frequency&#44; but their use in the diagnosis of respiratory-related sleep disturbances in children has not been demonstrated&#44; as was originally thought&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To describe the type of patients being monitored&#44; for how long and their outcome&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A retrospective descriptive study was conducted on patients with controlled home cardiorespiratory monitoring from October 2008 to September 2012 in the Outpatient department of a Maternity tertiary hospital&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">During the study period 88 patients were included&#44; 58&#37; of them were male&#44; with a median age of 15&#46;5 days&#44; and followed up for a period of 4&#46;7 months&#46; The reason for monitoring was due to a history of sudden death without finding underlying pathology in 20&#46;5&#37;&#44; 25&#37; due to apnea of prematurity&#44; 20&#46;5&#37; due to apparent life-threatening event&#44; and 14&#46;8&#37; due to choking&#46; Other causes accounted for 19&#46;3&#37; &#40;apnea&#47;hypopnea&#44; desaturation and periodic breathing&#41;&#46; Of these last three groups&#44; pathological events were observed in 50&#37; of them&#58; reflux disease &#40;9&#41;&#44; apnea of prematurity &#40;2&#41;&#44; neurological causes &#40;3&#41;&#44; and apnea of unknown cause &#40;10&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Suspected infant apnea is a cause for consultation that creates a great deal of concern to the family and the paediatrician&#46; Home monitoring is useful in detecting changes in cardiac and respiratory frequency&#44; but is necessary to limit its indications and ensure proper monitoring of these patients&#44; avoiding the abuse of other tests or treatments&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objective"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Material and methods"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Los monitores de apneas detectan anomal&#237;as en la frecuencia card&#237;aca y respiratoria&#44; sin utilidad demostrada para el diagn&#243;stico de alteraciones respiratorias relacionadas con el sue&#241;o en los ni&#241;os como se pensaba en su origen&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Describir el tipo de pacientes que se monitorizan&#44; durante cu&#225;nto tiempo y la evoluci&#243;n de los mismos&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Materiales y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo retrospectivo de los pacientes con monitorizaci&#243;n cardiorrespiratoria domiciliaria controlados&#44; desde octubre del 2008 hasta septiembre del 2012&#44; en consultas externas de un hospital materno-infantil de tercer nivel&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Durante el periodo de estudio fueron incluidos 88 pacientes&#44; el 58&#37; de ellos de sexo masculino&#44; con una mediana de edad de 15&#44;5 d&#237;as y durante un periodo de 4&#44;7 meses&#46; El motivo de monitorizaci&#243;n fue en un 20&#44;5&#37; por antecedente de muerte s&#250;bita&#44; sin encontrar patolog&#237;a subyacente&#59; un 25&#37; por apnea de la prematuridad&#59; un 20&#44;5&#37; por episodio aparentemente letal&#44; y un 14&#46;8&#37; por atragantamiento&#46; Otras causas suponen el 19&#44;3&#37; &#40;apnea&#47;hipopnea&#44; desaturaciones y respiraci&#243;n peri&#243;dica&#41;&#46; De estos 3 &#250;ltimos grupos&#44; en el 50&#37; se registraron eventos patol&#243;gicos&#58; reflujo patol&#243;gico &#40;9&#41;&#44; apneas de la prematuridad &#40;2&#41;&#44; causa neurol&#243;gica &#40;3&#41; y apneas de causa desconocida &#40;10&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La sospecha de apnea del lactante es un motivo de consulta que crea gran preocupaci&#243;n tanto a la familia como al pediatra&#46; La monitorizaci&#243;n domiciliaria es &#250;til en la detecci&#243;n de alteraciones en la frecuencia card&#237;aca y respiratoria pero es necesario limitar sus indicaciones y realizar un buen seguimiento de estos pacientes&#44; evitando el abuso de otras pruebas complementarias o tratamientos&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Objetivo"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Materiales y m&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mart&#237;nez Monseny A&#44; Bobillo P&#233;rez S&#44; Mart&#237;nez Planas A&#44; Garc&#237;a Garc&#237;a JJ&#46; Papel de las exploraciones complementarias y de la monitorizaci&#243;n domiciliaria en los pacientes de riesgo de episodio aparentemente letal&#44; apneas y s&#237;ndrome de muerte s&#250;bita del lactante&#46; An Pediatr &#40;Barc&#41;&#46; 2015&#59;83&#58;104&#8211;108&#46;</p>"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Apnoea of prematurity &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#41;</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">SIDS history &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#41;</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ALTE&#47;other &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>48&#41;</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Performed</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Performed</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Performed</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Abnormal</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Performed</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Abnormal</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">ECG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Echocardiography&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">UGI and small intestine series&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Videofluoroscopy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Neuroimaging&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">EEG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Polysomnography&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Metabolic screening&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab869289.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Tests performed in the study by reason for followup&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:16 [
            0 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric home apnea monitors coding&#44; billing&#44; and updated prescribing information for practice management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46;C&#46; Halbower"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.08-0538"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2008"
                        "volumen" => "134"
                        "paginaInicial" => "425"
                        "paginaFinal" => "429"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18682461"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Apnea&#44; sudden infant death syndrome and home monitoring"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Committe on Fetus and Newborn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2003"
                        "volumen" => "11"
                        "paginaInicial" => "914"
                        "paginaFinal" => "917"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Consensus development conference on infantile apnea and home monitoring&#46; National Institutes of Health"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "1987"
                        "volumen" => "79"
                        "paginaInicial" => "292"
                        "paginaFinal" => "299"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3808807"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Libro blanco de la muerte s&#250;bita del lactante &#40;SMSL&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Grupo de Trabajo para el Estudio y Prevenci&#243;n de la Muerte S&#250;bita Infantil de la Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "edicion" => "3rd ed&#46;"
                        "fecha" => "2013"
                        "editorial" => "Editorial Ergon"
                        "editorialLocalizacion" => "Madrid"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Why do ALTE infants not die in SIDS&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Edner"
                            1 => "M&#46; Wennborg"
                            2 => "B&#46; Alm"
                            3 => "H&#46; Lagercrantz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Paediatr"
                        "fecha" => "2007"
                        "volumen" => "96"
                        "paginaInicial" => "191"
                        "paginaFinal" => "194"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17429903"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "SIDS ALTE&#44; apnea&#44; and the use of home monitors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46;A&#46; Farrel"
                            1 => "G&#46;M&#46; Weiner"
                            2 => "J&#46;A&#46; Lemons"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Rev"
                        "fecha" => "2002"
                        "volumen" => "23"
                        "paginaInicial" => "3"
                        "paginaFinal" => "10"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11773587"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factor changes for sudden infant death syndrome after initiation of Back-to-Sleep campaign"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46;L&#46; Trachtenberg"
                            1 => "E&#46;A&#46; Haas"
                            2 => "H&#46;C&#46; Kinney"
                            3 => "C&#46; Stanley"
                            4 => "H&#46;F&#46; Krous"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2011-1419"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2012"
                        "volumen" => "129"
                        "paginaInicial" => "630"
                        "paginaFinal" => "638"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22451703"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0002937810000748"
                          "estado" => "S300"
                          "issn" => "00029378"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Precursors of cardiorespiratory events in infants detected by home memory monitor"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;E&#46; Hunt"
                            1 => "M&#46;J&#46; Corwin"
                            2 => "G&#46; Lister"
                            3 => "D&#46;E&#46; Weese-Mayer"
                            4 => "S&#46;L&#46; Davidson-Ward"
                            5 => "L&#46;R&#46; Tinsley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ppul.20745"
                      "Revista" => array:5 [
                        "tituloSerie" => "Pediatr Pulmonol"
                        "fecha" => "2008"
                        "volumen" => "43"
                        "paginaInicial" => "87"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18041078"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Apnea of prematurity&#58; from cause to treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Zhao"
                            1 => "F&#46; Gonzalez"
                            2 => "D&#46; Mu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Eur J Pediatr"
                        "fecha" => "2011"
                        "volumen" => "170"
                        "paginaInicial" => "1097"
                        "paginaFinal" => "1105"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluaci&#243;n y seguimiento de lactantes que sufrieron un episodio aparentemente letal"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Leal"
                            1 => "M&#46; Garc&#237;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "An Pediatr Contin"
                        "fecha" => "2010"
                        "volumen" => "8"
                        "paginaInicial" => "98"
                        "paginaFinal" => "103"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation and management of apparent life-threatening events in children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46;L&#46; Hall"
                            1 => "B&#46; Zalman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Fam Physician"
                        "fecha" => "2005"
                        "volumen" => "71"
                        "paginaInicial" => "2301"
                        "paginaFinal" => "2308"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15999867"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of apparent life-threatening events in infants&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;S&#46; Tieder"
                            1 => "R&#46;L&#46; Altman"
                            2 => "J&#46;L&#46; Bonkowsky"
                            3 => "D&#46;A&#46; Brand"
                            4 => "I&#46; Claudius"
                            5 => "D&#46;J&#46; Cunningham"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jpeds.2012.12.086"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2013"
                        "volumen" => "163"
                        "paginaInicial" => "94"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23415612"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "How to evaluate the child presenting with an apparent life-threatening event"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46; Weiss"
                            1 => "A&#46; Fattal-Valexski"
                            2 => "S&#46; Reif"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "IMAJ"
                        "fecha" => "2010"
                        "volumen" => "12"
                        "paginaInicial" => "154"
                        "paginaFinal" => "157"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20684179"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Causes of apparent life threatening events in infants&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;C&#46; McGovern"
                            1 => "M&#46;B&#46; Smith"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/adc.2003.031740"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dis Child"
                        "fecha" => "2004"
                        "volumen" => "89"
                        "paginaInicial" => "1043"
                        "paginaFinal" => "1048"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15499062"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of ECG use in infants with apparent life-threatening events&#58; a multicentre database study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;D&#46; Elias"
                            1 => "V&#46;R&#46; Iyer"
                            2 => "M&#46;S&#46; Cohen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PEC.0000000000000059"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatr Emerg Care"
                        "fecha" => "2014"
                        "volumen" => "30"
                        "paginaInicial" => "1"
                        "paginaFinal" => "4"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24365725"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0002937810008604"
                          "estado" => "S300"
                          "issn" => "00029378"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Apparent life-threatening events&#58; an update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46;Y&#46; Fu"
                            1 => "R&#46;Y&#46; Moon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/pir.33-8-361"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Rev"
                        "fecha" => "2012"
                        "volumen" => "33"
                        "paginaInicial" => "361"
                        "paginaFinal" => "369"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22855928"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/23412879/0000008300000002/v1_201508150053/S2341287915001386/v1_201508150053/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "26005"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008300000002/v1_201508150053/S2341287915001386/v1_201508150053/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001386?idApp=UINPBA00005H"
]

Article information

ISSN: 23412879
Original language: English

DOI:10.1016/j.anpede.2015.07.004

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	9	8	17
2024 October	42	34	76
2024 September	40	30	70
2024 August	62	56	118
2024 July	52	26	78
2024 June	39	23	62
2024 May	50	37	87
2024 April	42	24	66
2024 March	36	24	60
2024 February	41	25	66
2024 January	33	24	57
2023 December	43	28	71
2023 November	32	19	51
2023 October	28	22	50
2023 September	26	28	54
2023 August	25	19	44
2023 July	25	22	47
2023 June	28	26	54
2023 May	66	19	85
2023 April	39	14	53
2023 March	35	23	58
2023 February	26	21	47
2023 January	12	20	32
2022 December	56	25	81
2022 November	55	32	87
2022 October	31	39	70
2022 September	26	28	54
2022 August	31	53	84
2022 July	23	37	60
2022 June	35	36	71
2022 May	33	39	72
2022 April	22	40	62
2022 March	47	54	101
2022 February	33	24	57
2022 January	31	38	69
2021 December	25	40	65
2021 November	27	46	73
2021 October	38	48	86
2021 September	25	37	62
2021 August	33	51	84
2021 July	20	31	51
2021 June	35	46	81
2021 May	22	38	60
2021 April	63	62	125
2021 March	33	36	69
2021 February	18	26	44
2021 January	37	28	65
2020 December	37	30	67
2020 November	25	24	49
2020 October	31	19	50
2020 September	31	27	58
2020 August	15	14	29
2020 July	23	18	41
2020 June	32	13	45
2020 May	33	22	55
2020 April	31	18	49
2020 March	33	18	51
2020 February	29	18	47
2020 January	26	14	40
2019 December	18	22	40
2019 November	16	17	33
2019 October	19	17	36
2019 September	16	10	26
2019 August	24	16	40
2019 July	19	22	41
2019 June	31	24	55
2019 May	37	21	58
2019 April	23	27	50
2019 March	32	17	49
2019 February	30	18	48
2019 January	32	18	50
2018 December	45	36	81
2018 November	79	39	118
2018 October	113	34	147
2018 September	39	15	54
2018 August	1	0	1
2018 July	6	0	6
2018 June	5	0	5
2018 May	10	0	10
2018 April	18	0	18
2018 March	37	0	37
2018 February	17	0	17
2018 January	9	0	9
2017 December	10	0	10
2017 November	19	0	19
2017 October	8	0	8
2017 September	19	0	19
2017 August	17	0	17
2017 July	15	0	15
2017 June	25	7	32
2017 May	18	8	26
2017 April	81	9	90
2017 March	12	11	23
2017 February	6	9	15
2017 January	8	1	9
2016 December	30	4	34
2016 November	47	9	56
2016 October	47	10	57
2016 September	46	12	58
2016 August	46	15	61
2016 July	34	10	44

Show all

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter