Brief resolved unexplained event - BRUE


Definition

A brief resolved unexplained event (BRUE) is when an infant younger than one year stops breathing, has a change in muscle tone, turns pale or blue in color, or is unresponsive. The event occurs suddenly, lasts less than 30 to 60 seconds, and is frightening to the person caring for the infant.

BRUE is present only when there is no explanation for the event after a thorough history and exam. An older name used for these types of events is an apparent life-threatening event (ALTE).

Alternative Names

Apparent life-threatening event; ALTE

Causes

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It is unclear how often these events occur.

BRUE is NOT the same as sudden infant death syndrome (SIDS). It is also NOT the same as older terms such as "near-miss SIDS" or "aborted crib deaths," which are no longer used.

Events that involve a change in an infant's breathing, color, muscle tone, or behavior may be caused by an underlying medical problem. But these events would then NOT be considered a BRUE. Some of the causes for events that are NOT a BRUE include:

A specific cause of the event is found about half the time. In healthy children who only have one event, the cause is rarely identified.

The main risk factors for BRUE are:

Low birth weight, being born early, or secondhand smoke exposure also may be risk factors.

Symptoms

These events are more likely to occur during the first two months of life and between 8 a.m. and 8 p.m.

A BRUE  includes one or more of the following:

Choking or gagging means the event was likely not a BRUE. These symptoms are more likely caused by reflux.

Exams and Tests

The health care provider will ask you to describe what occurred during the event. The provider will also ask about:

When deciding if more testing is needed, the provider will consider:

A thorough physical exam will be done, checking for:

If there are no findings to suggest a high-risk BRUE, lab tests and imaging tests are often not needed. If choking or gasping occurred during feeding and the infant recovered quickly, more testing will often not be needed.

Factors that suggest a higher risk for recurrence or the presence of a serious cause include:

If risk factors are present, testing that may be done includes:

Treatment

If the event was brief, included no signs of breathing or heart problems, and corrected on its own, your child will likely not need to stay in the hospital.

Reasons your child may be admitted overnight include:

If admitted, your child's heart rate and breathing will be monitored.

The provider may recommend that you and other caregivers:

Although not common, home monitoring devices may be recommended.

Outlook (Prognosis)

Most often, these events are harmless and not a sign of more serious health problems or death.

BRUE is unlikely to be a risk for sudden infant death syndrome (SIDS). Most victims of SIDS do not have any types of events beforehand.

A child with risk factors for BRUE may have a higher risk for recurrence or the presence of a serious cause.

When to Contact a Medical Professional

Call the provider right away if child abuse is suspected. Possible signs of abuse include:

References

Tieder JS, Bonkowsky JL, Etzel RA, et al; Subcommittee on Apparent Life Threatening Events. Brief resolved unexplained events (formerly apparent life-threatening events) and evaluation of lower-risk infants. Pediatrics. 2016;137(5). PMID: 27244835. www.ncbi.nlm.nih.gov/pubmed/27244835. Accessed August 31, 2016.

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