title: Smaller mandibular size in infants with a history of an apparent life-threatening event.
abstract: OBJECTIVE
  To examine small mandibular size and preference for a hand-to-chin posture as salient characteristics in infants with a history of an apparent life-threatening event (ALTE).
  
  
  METHODS
  This was a prospective case-control study of term infants, from birth to 6 months of age, admitted post-ALTE and matched 1:2 with healthy control infants (age within 2 weeks and weight within 0.5 kg). Infants with confirmed gastroesophageal reflux and congenital anomalies, including severe micrognathia, were excluded.
  
  
  RESULTS
  Infants with a history of an ALTE (n = 25) were matched to 47 healthy controls. Infants with a history of an ALTE had mandibular indices (larger index indicates a smaller mandible) that were 3.8 mm greater on the left side (95% CI: 2.0-5.6, P < .001) and 4.2 mm greater on the right side (95% CI: 2.7-5.6, P < .001) adjusting for length and non-white race. Controlling for matching and length, a 1-mm increase in the average mandibular index increased the odds of an ALTE by 62% (OR = 1.62, 95% CI: 1.22-2.44, P < .001).
  
  
  CONCLUSIONS
  Smaller mandibular size was associated with ALTE, suggesting airway obstruction as a potential cause of ALTE. The association of this characteristic with ALTE also offers the potential for prospective quantification of ALTE risk.
authors.affiliation: Surgical Nursing, Children's Hospital Boston, Boston, MA 02115, USA. mary.horn@childrens.harvard.edu
authors.forename: Mary H
authors.initials: MH
authors.lastname: Horn
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Kinnamon
authors.forename: Nalton
authors.initials: N
authors.lastname: Ferraro
authors.forename: Martha A Q
authors.initials: MA
authors.lastname: Curley
mesh_terms: D000293:Adolescent; D000402:Airway Obstruction; D001049:Apnea; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004630:Emergencies; D005260:Female; D005683:Gagging; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008334:Mandible / Q000033:anatomy & histology*; D009929:Organ Size; D011187:Posture; D011446:Prospective Studies