title: Apparent Life-Threatening Events: Helping Infants Help Themselves.
abstract: OBJECTIVE
  Apparent life-threatening event (ALTE) refers to a constellation of unexpected events suddenly occurring in infants that extremely alarm the observers. The objectives of this study were to evaluate 1) intervention of Emergency Service (ES) at home, 2) parental behavior before ES intervention, 3) patients' outcome at follow-up of a minimum of 6 months.
  
  
  METHODS
  Retrospective study of infants younger than 12 months whose parents called ES and were evaluated for ALTE from 2005 to 2014. Tactile stimulation (TS) was defined as any maneuver performed by parents or ES staff aimed at rescuing patients without cardiopulmonary resuscitation attempts. Cardiopulmonary resuscitation was defined according to American Heart Association Guidelines 2010.
  
  
  RESULTS
  One hundred eighty-eight patients were eligible. Emergency Service provided intervention for 178 infants (10 were assisted only by phone). All patients received TS by parents before ES arrival. Mean time for ES to reach patient location was 15 ± 10 minutes. On examination, 136 patients (76.5%) seemed normal and 42 symptomatic. One hundred sixty-three patients were brought to the emergency department where 23 patients were found symptomatic. One hundred six of 163 patients underwent capillary blood gas determination and, in 28 (26%) of 106, alterations were found. No infant had subsequent cardiopulmonary arrest or clinically evident adverse neurological outcome. Six were found to be epileptic. No infant died during the episode or during follow-up.
  
  
  CONCLUSIONS
  Our findings suggest that ALTE is an alarming but self-limiting phenomenon that can be resolved either spontaneously or by simple TS in most cases. Emergency Service should solicit patients' physiological responses through TS first while considering a cardiopulmonary resuscitation maneuver.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vigo
authors.affiliation: Department of Anaesthesia and Intensive Care, Città della Salute e della Scienza.
authors.forename: Roberto
authors.initials: R
authors.lastname: Balagna
authors.forename: Luca
authors.initials: L
authors.lastname: Brazzi
authors.forename: Giulia
authors.initials: G
authors.lastname: Costagliola
authors.affiliation: Department of Anesthesia and Intensive Care, DiBiMed, Policlinico P. Giaccone, University of Palermo, Palermo, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Gregoretti
authors.forename: Maria Maddalena
authors.initials: MM
authors.lastname: Lupica
authors.forename: Silvia
authors.initials: S
authors.lastname: Noce
mesh_terms: D004630:Emergencies / Q000453:epidemiology*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017063:Outcome Assessment, Health Care; D010290:Parents; D012189:Retrospective Studies