Brief resolved unexplained event

Brief Resolved Unexplained Event (BRUE) is a term used in pediatric medicine to describe an incident occurring in an infant that is alarming to the observer, but where the cause of the event remains unclear even after a thorough investigation. These events were previously known as Apparent Life-Threatening Events (ALTE), but the terminology was updated to BRUE by the American Academy of Pediatrics in 2016 to more accurately describe these incidents without implying a life-threatening prognosis.

Definition

A BRUE is diagnosed when an infant younger than one year experiences an episode that is sudden, brief (less than one minute), and now resolved, with the event having at least one of the following characteristics:

• Cyanosis or pallor
• Absent, decreased, or irregular breathing
• Marked change in tone (hypertonia or hypotonia)
• Altered level of responsiveness

The event must be unexplained after conducting an appropriate history and physical examination, meaning that there is no identifiable medical condition that explains the episode.

Classification

BRUEs are classified into two categories based on risk: low-risk and high-risk. This classification helps guide further evaluation and management.

• Low-risk BRUE: This category includes infants who are older than 60 days, born after 32 weeks gestation and corrected for prematurity, have no history of similar events, and who exhibit no concerning features during history taking and physical examination.
• High-risk BRUE: Infants not meeting the criteria for low-risk BRUE are considered high-risk. These infants may require more extensive evaluation and monitoring.

Evaluation

The evaluation of an infant after a BRUE may include, but is not limited to:

• Detailed medical history, including prenatal, birth, and family history
• Physical examination focusing on neurological and respiratory systems
• Appropriate laboratory tests and imaging studies based on clinical judgment

Management

Management strategies for BRUE are tailored based on the risk assessment:

• Low-risk BRUE: Infants can often be managed with careful observation and possibly brief hospitalization. Parental education on safe infant care practices and the benign nature of most BRUEs is crucial.
• High-risk BRUE: These infants may require hospitalization for monitoring, further diagnostic evaluation, and possibly treatment for any underlying conditions identified.

Prognosis

The prognosis for infants who experience a BRUE is generally good, especially for those classified as low-risk. However, the underlying cause of the event, if identified, may influence the long-term outlook.

Prevention

Preventive measures for BRUE are not well-defined due to the unexplained nature of these events. However, following safe sleep guidelines and ensuring a smoke-free environment for the infant are recommended.

See Also

• Sudden infant death syndrome
• Pediatric emergency medicine
• Infant respiratory distress syndrome