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Table 4 Objective examination for the assessment of a potential ALTE [43, 46, 47]

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

• Weight, length, head circumference
• Monitoring of the vital functions: heart rate (HR), respiratory rate (RR), blood pressure (BP), skin temperature, Sp,O2
• Type of crying
• Respiratory function
• Skin colour, skin perfusion (capillary refilling time)  
• State of hydration
• Eye assessment (extra-ocular movements, pupillary response, conjunctival bleeding, examination of the retina if indicated)
• Examination of ear and oropharynx (nasal congestion and secretions, blood in nostrils or oral cavity, evidence of injuries or obstructions, tearing of frenulum)
• Search for possible craniofacial dysmorphisms (mandible, jaw, nose)
• Assessment of the neck mobility
• Peripheral pulses, rhythm, rate, heart auscultation
• Physical examination of the abdomen (organomegaly, masses, abdominal distension), inspection of genitals
• Anterior fontanel tension, shape of head, bruises or other lesions
• Palpation of ribs for possible yielding, crepitus, irregularities
• Limbs: muscle tone, lesions, deformities with possible fractures  
• Neurobehavioural assessment, muscle tone, reflexes
• Neurological assessment (reactivity to external stimuli, response to sound and visual stimuli, general tone, pupillary reflexes to light, symmetry of the movement, tone and strength)
• Presence of meningeal symptoms