Brief resolved unexplained event: Difference between revisions
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{{Infobox medical condition | |||
| name = Brief resolved unexplained event | |||
| synonyms = BRUE, Apparent life-threatening event (ALTE) | |||
| field = [[Pediatrics]] | |||
| symptoms = [[Apnea]], [[cyanosis]], [[muscle tone]] changes, [[altered level of consciousness]] | |||
| onset = Typically in infants <1 year old | |||
| duration = Less than 1 minute | |||
| causes = Unknown, but may include [[gastroesophageal reflux disease]], [[seizures]], [[respiratory infections]] | |||
| risks = [[Premature birth]], history of similar events | |||
| diagnosis = Clinical evaluation, exclusion of other causes | |||
| differential = [[Seizure disorder]], [[gastroesophageal reflux disease]], [[respiratory infection]], [[child abuse]] | |||
| treatment = Observation, reassurance, addressing underlying causes if identified | |||
| prognosis = Generally good, low risk of recurrence | |||
| frequency = Common in infants, exact prevalence unknown | |||
}} | |||
'''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. | '''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== | ==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: | 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: | ||
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* Marked change in tone (hypertonia or hypotonia) | * Marked change in tone (hypertonia or hypotonia) | ||
* Altered level of responsiveness | * 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. | 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== | ==Classification== | ||
BRUEs are classified into two categories based on risk: ''low-risk'' and ''high-risk''. This classification helps guide further evaluation and management. | 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. | * '''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. | * '''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== | ==Evaluation== | ||
The evaluation of an infant after a BRUE may include, but is not limited to: | The evaluation of an infant after a BRUE may include, but is not limited to: | ||
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* Physical examination focusing on neurological and respiratory systems | * Physical examination focusing on neurological and respiratory systems | ||
* Appropriate laboratory tests and imaging studies based on clinical judgment | * Appropriate laboratory tests and imaging studies based on clinical judgment | ||
==Management== | ==Management== | ||
Management strategies for BRUE are tailored based on the risk assessment: | 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. | * '''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. | * '''High-risk BRUE''': These infants may require hospitalization for monitoring, further diagnostic evaluation, and possibly treatment for any underlying conditions identified. | ||
==Prognosis== | ==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. | 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== | ==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. | 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== | ==See Also== | ||
* [[Sudden infant death syndrome]] | * [[Sudden infant death syndrome]] | ||
* [[Pediatric emergency medicine]] | * [[Pediatric emergency medicine]] | ||
* [[Infant respiratory distress syndrome]] | * [[Infant respiratory distress syndrome]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Respiratory system]] | [[Category:Respiratory system]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
{{medicine-stub}} | {{medicine-stub}} | ||
{{No image}} | |||
Latest revision as of 05:28, 4 April 2025
| Brief resolved unexplained event | |
|---|---|
| Synonyms | BRUE, Apparent life-threatening event (ALTE) |
| Pronounce | N/A |
| Specialty | N/A |
| Symptoms | Apnea, cyanosis, muscle tone changes, altered level of consciousness |
| Complications | N/A |
| Onset | Typically in infants <1 year old |
| Duration | Less than 1 minute |
| Types | N/A |
| Causes | Unknown, but may include gastroesophageal reflux disease, seizures, respiratory infections |
| Risks | Premature birth, history of similar events |
| Diagnosis | Clinical evaluation, exclusion of other causes |
| Differential diagnosis | Seizure disorder, gastroesophageal reflux disease, respiratory infection, child abuse |
| Prevention | N/A |
| Treatment | Observation, reassurance, addressing underlying causes if identified |
| Medication | N/A |
| Prognosis | Generally good, low risk of recurrence |
| Frequency | Common in infants, exact prevalence unknown |
| Deaths | N/A |
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[edit]
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[edit]
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[edit]
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[edit]
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[edit]
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[edit]
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.
