title: Incidence of apparent life-threatening events and post-neonatal risk factors.
abstract: OBJECTIVE
  Even though a standard clinical definition for an apparent life-threatening event (ALTE) was established more than two decades ago, the specific International Classification of Disease (ICD) code was firstly included only in 2012. This study estimated the incidence of ALTEs in Northern Italy, together with features and risk factors.
  
  
  METHODS
  We used the Lombardy Region Hospital Discharge Records (HDR) database to estimate the cumulative incidence for ALTE during 2002-2006 and drew up a risk profile by comparing cases with and without ALTE who were followed in infancy.
  
  
  RESULTS
  There were 246 infants registered in the HDR with ALTE putative diagnostic codes, suggesting a cumulative incidence of 4.1 per 1000 live births in the study area. Of the 148 cases with clinical co-morbidities, 31% had gastroesophageal reflux and 7% had acute respiratory infections. We analysed follow-up data from 15 ALTE cases and 1619 healthy infants and found that the significant risk factors were gastroesophageal reflux and a family history of sudden death.
  
  
  CONCLUSIONS
  We established the regional incidence of ALTE and found risk factors in infants considered healthy in the first week of life and without pathological perinatal conditions. The systematic use of the specific ALTE ICD code (R68.13, ICD-10-CM) and common knowledge about ALTE diagnostic guidelines are clearly needed.
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy.
authors.forename: Maria Cristina
authors.identifier: http://orcid.org/0000-0003-1586-527X
authors.initials: MC
authors.lastname: Monti
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Borrelli
authors.affiliation: Pediatric Emergency Room, Pediatric Department, University of Varese, Varese, Italy.
authors.forename: Luana
authors.initials: L
authors.lastname: Nosetti
authors.affiliation: Pediatric Emergency Room, Pediatric Department, University of Varese, Varese, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Tajè
authors.affiliation: Pediatric Arrhythmias Center, IRCCS Istituto Auxologico Italiano, Milan, Italy.
authors.forename: Milena
authors.initials: M
authors.lastname: Perotti
authors.affiliation: Epidemiology Observatory, Varese Local Health Authority, Varese, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Bonarrigo
authors.affiliation: Pediatric Arrhythmias Center, IRCCS Istituto Auxologico Italiano, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Stramba Badiale
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Montomoli
mesh_terms: D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology*; D007558:Italy / Q000453:epidemiology; D008297:Male; D012307:Risk Factors
keywords: Apparent life-threatening event; Gastroesophageal reflux; Hospital discharge records; Incidence; Infant morbidity