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Table 3 Useful anamnestic data in the assessment of a potential ALTE [12, 16, 44, 84]

From: Apparent Life-Threatening Events (ALTE): Italian guidelines

Family history  
 History of SUDI or SIDS  
 Cases of ALTE/BRUE in family members  
 Heart diseases (arrhythmias, long-QT syndrome, syncope)  
 Hereditary/genetic/metabolic diseases  
 Allergic diseases  
 Epilepsy, breath-holding spells, delayed growth  
 Malformations (craniofacial, musculoskeletal)  
Past medical history  
 Pre-perinatal history  
 Prematurity  
 Birth  
 Neonatal weight  
 APGAR score  
 Normal neonatal screenings  
 Breastfeeding  
 Complementary feeding  
 Height-weight increase  
 Adequate psycho-motor development  
 Heart diseases  
 Neurological diseases  
 Previous episodes of ALTE/BRUE  
 Feeding problems (GER)  
 Sleep and respiratory disorders during sleep (snoring, apnoea)  
 Respiratory disorders while awake (noisy breathing)  
 Trauma, emergencies  
 Previous hospitalisation, surgery  
 Immunizations  
 Drug assumption  
 Other  
Recent history  
 Infant’s general condition over the last 48 h (respiratory tract infections, immunizations, fever, other)  
 Injuries, falls, recent unexplainable bruising  
 Drug assumption  
 Introduction of new foods  
 Change of feeding schedule  
 Sleep deprivation  
 Alteration of normal sleeping-wake pattern and/or lethargy  
History of the event  
 General description  
 The person reporting the event  
 Witness of the event (parents, other children, other adults)  
 Reliability of the narrator  
Circumstances of the event  
 Where it happened (at home or elsewhere; in bed, in cot, on sofa, on floor, etc.)  
 Position: supine, prone, erect, sitting, in movement  
 During sleep: indicate whether infant emitted sounds immediately beforehand, had noisy breathing, coughed, vomited, etc.  
 While awake: indicate whether immediately beforehand the child coughed, vomited, cried in an unusual manner, went stiff, or breathed in food  
 While feeding  
 During bath time  
 Time elapsed since last feed  
 Environmental risk factors: cigarette smoking, carbon monoxide, ambient temperature, clothes, objects too close to the infant, noises, accidental causes  
 Psychological factors  
Infant’s appearance during the event  
 Skin colour: pale, cyanotic, erythrosic, ashen, marbled  
 Colour of the lips: normal, pale, cyanotic  
 Muscle tone: normal, hypotonia, hypertonia  
 State of consciousness  
 Jerking of the limbs  
 Body temperature: hypo-hyperthermia  
 Profuse or absent sweating  
 Respiratory distress  
 Apnoea  
 Bleeding  
End of the event and actions taken  
 Time elapsing between the onset of symptoms and first intervention  
 Time elapsing between intervention and resumption of breathing and regaining of normal appearance and behaviour  
 Did the episode clear up spontaneously or after stimulation?  
 Did the episode clear up after vigorous and prolonged stimulation or resuscitation manoeuvres?  
 Did the episode end abruptly or gradually?  
 Were the resuscitation manoeuvres carried out by parents or by others?  
 Before returning to normal was the child calm, confused, agitated, irritable, crying?  
 Was the emergency service called?  
Socio-Environmental History  
 Family structure, independent home (one or more families)  
 Home in good condition (no mould, etc.)  
 Recent changes, stressful conditions or internal conflict  
 Exposure to toxic substances and drugs  
 Need to access social services  
 Level of family anxiety  
 Contact of the infant with adults with a history of mental illness or substance abuse  
Indexes of suspected or possible abuse  
 Previous assistance by the social services of the juvenile court (domestic violence, abuse)  
 Repeated changes in the version recounted of the circumstances of the event  
 History of unexplainable bruises  
 History incompatible with the infant’s psychomotor development  
 Incongruence between the observations of the person taking care of the infant and the latter’s psychomotor development, with the infant blamed for bad behaviour