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Brief resolved unexplained event (BRUE) in infants[1]

Brief resolved unexplained event (BRUE) in infants[1]
Definition:
A sudden, brief, and now resolved* episode in an infant that includes 1 or more of the following features:
  • Cyanosis or pallor
  • Absent, decreased, or irregular breathing
  • Marked change in tone (hyper- or hypotonia)
  • Altered level of responsiveness
The term should be applied only when there is no explanation for the episode after a focused history and physical examination.
Low-risk characteristics:
Infants who have experienced BRUE are at low risk for having a recurrence or serious underlying disorder if they have all of the following characteristics:
  • Age >60 days
  • If premature, born at gestational age ≥32 weeks and current postconceptional age is ≥45 weeks
  • Occurrence of only 1 BRUE (no prior BRUE, and BRUE did not occur in clusters)
  • Duration of BRUE <1 minute
  • No cardiopulmonary resuscitation (CPR) by a trained medical provider was required
  • No concerning historical features
  • No concerning physical examination findingsΔ
BRUE: brief resolved unexplained event.
* The term "brief" indicates that the estimated duration of the event was less than 1 minute (although this estimate is often inaccurate). "Resolved" indicates that the infant is asymptomatic on presentation after the event.
¶ Concerning historical features include social risk factors for child abuse, respiratory illness or exposure, recent injury, other symptoms in days preceding the event (fever, fussiness, diarrhea, or decreased intake), administration or access to medications, history of episodic vomiting or lethargy, developmental delay or congenital anomalies, family history of BRUE, or sudden unexplained death in a sibling.
Δ Concerning physical examination findings include any signs of injury, including bleeding or bruising (especially on the scalp trunk, face, or ears), or bulging anterior fontanel; altered sensorium; fever or toxic appearance; respiratory distress; and abdominal distension or vomiting.
Reference:
  1. Tieder JS, Bonkowsky JL, Etzel RA, et al. Brief resolved unexplained events (formerly apparent life-threatening events) and evaluation of lower-risk infants: Executive summary. Pediatrics 2016; 137:e20160591.
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