Despite the seriousness of apparent life threatening events (ALTE), little is known about their epidemiology. The objective of this study was to derive a profile of 153 ALTE's recruited into the Collaborative Home Infant Evaluation (CHIME) and to compare it with published risk factors for sudden infant death syndrome (SIDS). 127 (83%) of the infants presented with classical features of apnea with either or both color and muscle tone changes. 12/127 (9%) had in addition choking, gagging, or vomiting. Twenty-six (17%) of the infants did not have apnea but had either change in color or muscle tone and most had both. Of these, 7 had minimal stimulation comprising those with the least serious event. Interventions were classified as vigorous stimulation (50%), mouth-to-mouth resuscitation (13%), chest compression (4%); 18% had more than one. Infants were followed for a minimum of 1 week to a maximum of 76 weeks with a median of 15 weeks. None died during follow-up. In contrast to SIDS mothers, the ALTE mothers were neither young nor old. The majority of ALTE were first born. One third of the mothers smoked, in contrast to more than two thirds of SIDS mothers. Most ALTE's occurred when the infants were 0-2 months old rather than 2-4 months as in SIDS. 34 (22%) of the infants were awake and 22 (14%) were in the supine sleeping position when the ALTE occurred. There was an excessive number of apnea and SIDS in family members of the ALTE group, not in siblings but in peripheral relatives. Preterm infants were over represented in both ALTE and SIDS. ALTE's were different from SIDS in age of mother, maternal smoking, birth order, timing of the episode, number of infants awake, and incidence in siblings. Cases were recruited based on parental selection influenced by their impression of the seriousness of the attack. In conclusion, the ALTE profile differs significantly from that of SIDS and calls into question their relationship.
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