275:
ingestion of medications or poisons. Also, for infants in the high-risk category, clinicians should consider admission to the hospital for extended observation, depending on the benefits and risk of the case. The course of the admission provides an opportunity to witness a second event to better characterize it and narrow the list of possible diagnoses. The observation of infants at home with the help of medical devices after discharge is not recommended.
118:. Evaluation after an ALTE or BRUE is diagnostically important, as some events represent the first sign or symptom of an underlying medical condition. In most cases, assuming the infants are otherwise healthy and no underlying medical issue is found, the infants who have a BRUE are unlikely to have a second event and have an even smaller risk of death.
127:
abnormalities, such as lack of breathing, slow breathing, or irregular breathing may be noted. Differences in muscle tone, such as transient floppiness or rigidity can also be characterized as a BRUE. Changes in level of responsiveness such as abnormal eye contact or inability to interact can also fulfill the classification.
106:(AAP) clarified the use of both terms in a 2016 consensus statement that recommended the term BRUE be used whenever possible as it is more specifically defined. Thus, it is more useful for assessing risk of further events. The cause for BRUEs is often unknown, although some of the more common causes include
333:
is more common. Because of this, a BRUE can also be considered as a subset of ALTE. The term change was also recommended in large part due to the "life-threatening" suggestion from the older term. The rate of death in infants following a BRUE has been studied and is relatively rare, about 1 in 800.
274:
For infants that have concerning features on history or physical, and are thus categorized as high-risk, further evaluation is warranted. This will vary greatly depending on the infants symptoms, but may include, urinalysis, complete blood count, imaging with chest x-ray, and laboratory screening for
261:
If the infant does not meet all of these criteria, the BRUE is considered high-risk, and more likely represents an underlying medical condition. Characteristics of the infant that make this more likely include history of similar events or clustering, history of unexpected death in a sibling, need for
130:
A BRUE is a term used by a clinician to characterize an infant's self-limited episode witnessed by someone else. The AAP defines a BRUE as a sudden, brief episode that occurs to infants less than 1 year of age, lasts less than one minute, and resolves completely on its own prior to being evaluated by
332:
The biggest difference is whether the infant is symptomatic at time of presentation to a health professional. If the infant is still showing symptoms, then the condition is termed an ALTE. In order to be considered a BRUE, the infant should be completely asymptomatic at time of presentation, which
270:
If the infant meets criteria for a low-risk BRUE and the clinician feels there are no concerning findings otherwise, treatment often involves simple short observation in the emergency department with pulse oximetry. For the cases where parents complain of specific symptoms at the time of the event,
126:
A BRUE is a description of a self-limited episode. Usually a BRUE lasts for less than 1 minute. By definition, the episode must have resolved by the time the infant is evaluated by a medical professional. The caregiver may report observation of bluish skin discoloration, called cyanosis. Breathing
283:
The risk of death of patients who have a BRUE has been studied by using the literature about ALTEs, since this data is more abundant. The studies concluded that there is no increased risk of death for these patients compared to the rest of the infant population. As for the prognosis of these
211:
Taking the history of the event is vital in the evaluation of a BRUE. The first step is determining whether this is truly a BRUE by looking for presence of abnormal symptoms or vital signs. If this is the case, then it cannot be labelled as a BRUE and the healthcare professional should treat
166:
that leads to a BRUE or ALTE. This is a likely cause if the infant had vomiting or regurgitation just prior to the event, or if the event occurred while the infant was awake and lying down. In healthy infants with a suggestive GER event, no additional testing is typically done. In infants with
153:
Most infants who have a BRUE are never diagnosed with a definitive cause for the event. However, we use the literature on ALTEs, which is more extensive, to help explain the cause of a BRUE. These causes may also be considered conditions that can be confused with a BRUE.
414:
Tieder, J. S.; Bonkowsky, J. L.; Etzel, R. A.; Franklin, W. H.; Gremse, D. A.; Herman, B.; Katz, E. S.; Krilov, L. R.; Merritt, J. L.; Norlin, C.; Percelay, J.; Sapien, R. E.; Shiffman, R. N.; Smith, M. B. H.; SUBCOMMITTEE ON APPARENT LIFE THREATENING EVENTS (Apr 2016).
312:
in these infants, but more recently the research has concluded that there is no direct relationship between an ALTE and SIDS. It also was defined as part of an attempt to characterize the different forms of apnea, or sudden lack of breathing, in infants.
220:
The next step in evaluation is distinguishing whether this BRUE is low- or high-risk. The
American Academy of Pediatrics classifies an infant as low risk if they have a BRUE and meet the following characteristics:
356:"Tieder JS, Bonkowsky JL, Etzel RA, et al. Clinical Practice Guideline: Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants: Executive Summary"
695:
87:. The event is noted by an observer, typically the infant's caregiver. It is characterized by one or more concerning symptoms such as change in skin color, lack of
662:
554:
262:
CPR by a trained medical professional, ongoing lethargy, suspicion for child abuse or maltreatment, or existence of genetic syndrome or congenital anomalies.
99:
environment they must be back to normal without obvious explanation after the clinician takes the appropriate clinical history and physical examination.
601:
196:
300:) as an observed frightening event of an infant that includes at least one component of lack of breathing (apnea), skin color change (such as
638:
577:
530:
304:), weakness, choking, or gagging. The term was invented to avoid previously used terms such as "near-miss SIDS" to dissociate the event from
271:
then follow-up testing may be done for the related conditions or diseases. Other tests are not typically recommended for low-risk infants.
521:
Kliegman, Robert; Stanton, Bonita; St. Geme, Joseph W. III; Schor, Nina Felice; Behrman, Richard E.; Nelson, Waldo E. (2015-04-17).
107:
317:
103:
755:
240:
309:
305:
228:
417:"Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants"
666:
308:, a separate condition in infancy. There had been literature discussion in the past about the increased risk of
416:
728:
602:"The National Institutes of Health (NIH) Consensus Development Program: Infantile Apnea and Home Monitoring"
192:
188:
180:
167:
repeated episodes of choking or repeated acute events, evaluation with a swallowing study can be helpful.
284:
infants into adulthood, research still needs to be conducted to assess for any long-term health effects.
28:
609:
328:
The guidelines state that the term ALTE is still applicable with key differences between ALTE and BRUE
760:
465:"Risk of Death in Infants Who Have Experienced a Brief Resolved Unexplained Event: A Meta-Analysis"
200:
689:
656:
548:
17:
644:
634:
583:
573:
536:
526:
494:
486:
438:
385:
377:
53:
476:
428:
367:
749:
111:
633:. Shaw, Kathy N.,, Bachur, Richard G. (Seventh ed.). Philadelphia. 2015-11-11.
163:
733:
481:
464:
115:
96:
320:(AAP) published a clinical practice guideling recommending the replacement of
176:
80:
648:
587:
540:
490:
381:
131:
a health professional. The event must include at least one of the following:
95:, or poor responsiveness. By definition, by the time they are assessed in a
88:
498:
442:
433:
389:
372:
355:
301:
92:
720:
570:
The
Harriet Lane handbook : a manual for pediatric house officers
183:, breath-holding spells, congenital central hypoventilation syndrome,
184:
84:
631:
Fleisher & Ludwig's textbook of pediatric emergency medicine
191:, apnea of infancy, periodic breathing of infancy, choking,
572:(20th ed.). Philadelphia, PA: Elsevier/Saunders.
292:
In 1986, the
National Institute of Health defined an
135:
skin color change to blue (cyanosis) or pale (pallor)
710:
463:
Brand, Donald A.; Fazzari, Melissa J. (2018-06-01).
714:
52:
44:
39:
682:The Encyclopedia of Children's Health and Wellness
684:. New York, NY: Facts on File, Inc. p. 36.
568:Flerlage, Jamie; Engorn, Branden, eds. (2015).
162:Vomiting or choking during feeding can trigger
525:(20th ed.). Philadelphia, Pennsylvania.
8:
694:: CS1 maint: multiple names: authors list (
243:(CPR) by a medical provider was not required
249:no concerning physical examination findings
83:that describes an event that occurs during
27:"BRUE" redirects here. For other uses, see
711:
661:: CS1 maint: location missing publisher (
553:: CS1 maint: location missing publisher (
175:Other causes that are less common include
36:
480:
432:
409:
407:
405:
403:
401:
399:
371:
680:Turkington, C., & Tzeel, A. (2004).
326:brief resolved unexplained event (BRUE).
342:
687:
654:
546:
197:factitious disorder imposed on another
225:infant is of age greater than 60 days
7:
516:
514:
512:
510:
508:
458:
456:
454:
452:
350:
348:
346:
237:this BRUE did not occur in a cluster
48:Acute life-threatening event (ALTE)
25:
246:no concerning features on history
231:greater than or equal to 32 weeks
65:Brief resolved unexplained event
40:Brief resolved unexplained event
294:apparent life-threatening event
73:apparent life-threatening event
18:Apparent life-threatening event
318:American Academy of Pediatrics
104:American Academy of Pediatrics
1:
523:Nelson textbook of pediatrics
252:duration less than 20 seconds
241:cardiopulmonary resuscitation
234:infant has had no prior BRUEs
482:10.1016/j.jpeds.2017.12.028
777:
366:(2): e20161488. May 2016.
26:
469:The Journal of Pediatrics
144:decreased responsiveness
79:), is a medical term in
193:obstructive sleep apnea
181:urinary tract infection
158:Gastroesophageal reflux
108:gastroesophageal reflux
434:10.1542/peds.2016-0590
373:10.1542/peds.2016-1488
665:) CS1 maint: others (
29:Brue (disambiguation)
201:Munchausen syndrome
189:intracranial bleed
138:abnormal breathing
116:child maltreatment
756:Children's health
743:
742:
640:978-1-4963-2698-0
606:consensus.nih.gov
579:978-0-323-11246-8
532:978-0-323-26352-8
324:with a new term,
257:High-risk infants
62:
61:
34:Medical condition
16:(Redirected from
768:
712:
700:
699:
693:
685:
677:
671:
670:
660:
652:
627:
621:
620:
618:
617:
608:. Archived from
598:
592:
591:
565:
559:
558:
552:
544:
518:
503:
502:
484:
460:
447:
446:
436:
427:(5): e20160590.
411:
394:
393:
375:
352:
216:Low-risk infants
37:
21:
776:
775:
771:
770:
769:
767:
766:
765:
746:
745:
744:
739:
738:
723:
709:
704:
703:
686:
679:
678:
674:
653:
641:
629:
628:
624:
615:
613:
600:
599:
595:
580:
567:
566:
562:
545:
533:
520:
519:
506:
462:
461:
450:
413:
412:
397:
354:
353:
344:
339:
290:
281:
268:
259:
229:gestational age
218:
209:
173:
160:
151:
141:muscle weakness
124:
35:
32:
23:
22:
15:
12:
11:
5:
774:
772:
764:
763:
758:
748:
747:
741:
740:
737:
736:
724:
719:
718:
716:
715:Classification
708:
707:External links
705:
702:
701:
672:
639:
622:
593:
578:
560:
531:
504:
448:
395:
341:
340:
338:
335:
289:
286:
280:
277:
267:
264:
258:
255:
254:
253:
250:
247:
244:
238:
235:
232:
226:
217:
214:
208:
205:
172:
169:
159:
156:
150:
147:
146:
145:
142:
139:
136:
123:
120:
71:), previously
60:
59:
56:
50:
49:
46:
42:
41:
33:
24:
14:
13:
10:
9:
6:
4:
3:
2:
773:
762:
759:
757:
754:
753:
751:
735:
731:
730:
726:
725:
722:
717:
713:
706:
697:
691:
683:
676:
673:
668:
664:
658:
650:
646:
642:
636:
632:
626:
623:
612:on 2020-01-14
611:
607:
603:
597:
594:
589:
585:
581:
575:
571:
564:
561:
556:
550:
542:
538:
534:
528:
524:
517:
515:
513:
511:
509:
505:
500:
496:
492:
488:
483:
478:
474:
470:
466:
459:
457:
455:
453:
449:
444:
440:
435:
430:
426:
422:
418:
410:
408:
406:
404:
402:
400:
396:
391:
387:
383:
379:
374:
369:
365:
361:
357:
351:
349:
347:
343:
336:
334:
331:
327:
323:
319:
316:In 2016, the
314:
311:
307:
303:
299:
295:
287:
285:
278:
276:
272:
265:
263:
256:
251:
248:
245:
242:
239:
236:
233:
230:
227:
224:
223:
222:
215:
213:
212:accordingly.
206:
204:
202:
198:
194:
190:
186:
182:
178:
170:
168:
165:
157:
155:
148:
143:
140:
137:
134:
133:
132:
128:
121:
119:
117:
113:
109:
105:
100:
98:
94:
90:
86:
82:
78:
74:
70:
66:
57:
55:
51:
47:
43:
38:
30:
19:
727:
681:
675:
630:
625:
614:. Retrieved
610:the original
605:
596:
569:
563:
522:
472:
468:
424:
420:
363:
359:
329:
325:
321:
315:
297:
293:
291:
282:
273:
269:
260:
219:
210:
174:
171:Other causes
164:laryngospasm
161:
152:
129:
125:
122:Presentation
101:
76:
72:
68:
64:
63:
45:Other names
761:Pediatrics
750:Categories
616:2020-01-14
421:Pediatrics
360:Pediatrics
337:References
266:Management
199:(formerly
177:meningitis
97:healthcare
81:pediatrics
58:Pediatrics
690:cite book
657:cite book
649:953862907
588:877822265
549:cite book
541:909902899
491:0022-3476
475:: 63–67.
382:1098-4275
279:Prognosis
207:Diagnosis
89:breathing
54:Specialty
499:29398048
443:27244835
390:27474017
302:cyanosis
93:weakness
734:D057768
288:History
112:seizure
85:infancy
647:
637:
586:
576:
539:
529:
497:
489:
441:
388:
380:
185:cancer
149:Causes
114:, and
729:MeSH
696:link
667:link
663:link
645:OCLC
635:ISBN
584:OCLC
574:ISBN
555:link
537:OCLC
527:ISBN
495:PMID
487:ISSN
439:PMID
386:PMID
378:ISSN
322:ALTE
310:SIDS
306:SIDS
298:ALTE
102:The
77:ALTE
69:BRUE
477:doi
473:197
429:doi
425:137
368:doi
364:138
203:).
752::
732::
692:}}
688:{{
659:}}
655:{{
643:.
604:.
582:.
551:}}
547:{{
535:.
507:^
493:.
485:.
471:.
467:.
451:^
437:.
423:.
419:.
398:^
384:.
376:.
362:.
358:.
345:^
195:,
187:,
179:,
110:,
91:,
721:D
698:)
669:)
651:.
619:.
590:.
557:)
543:.
501:.
479::
445:.
431::
392:.
370::
330:.
296:(
75:(
67:(
31:.
20:)
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.