Brief Resolved Unexplained Event

Brief Resolved Unexplained Event (BRUE) is a term used in the medical field 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 condition.

Definition

A BRUE is defined by the following criteria:

• Occurs in an infant younger than one year old
• Sudden, brief (less than one minute), and now resolved episode of one or more of the following:
  • Cyanosis or pallor
  • Absent, decreased, or irregular breathing
  • Marked change in tone (hypertonia or hypotonia)
  • Altered level of responsiveness
• No explanation for the event after conducting a thorough history and physical examination

Classification

BRUEs are classified into two categories based on risk:

• Low-risk BRUE: This category includes infants older than 60 days, born after 32 weeks gestation, with no history of prematurity, and the event lasted less than one minute without recurrence. These infants also have no concerning historical features or physical examination findings.
• High-risk BRUE: Infants who do not meet the criteria for low-risk BRUE are considered high-risk. These events may require further investigation to determine the underlying cause.

Causes

The exact cause of a BRUE is, by definition, unknown. However, potential underlying conditions that might lead to a BRUE include:

• Gastroesophageal reflux disease (GERD)
• Seizure disorders
• Respiratory infections or disorders
• Cardiac conditions
• Metabolic disorders
• Child abuse or neglect

Evaluation

The evaluation of an infant after a BRUE includes a detailed history and physical examination. The goal is to identify any possible underlying conditions that could have led to the event. For low-risk BRUE, minimal testing is recommended unless the history and physical examination suggest a specific condition. For high-risk BRUE, further diagnostic testing may include:

• Electrocardiogram (ECG)
• Blood tests
• Neuroimaging
• Overnight polysomnography

Management

Management strategies for BRUE are tailored based on the risk assessment. For low-risk BRUE, educating the caregivers about the event and ensuring a safe sleep environment may be all that is required. High-risk BRUE may necessitate hospitalization for monitoring and further evaluation. In all cases, it is crucial to provide support and reassurance to the caregivers, addressing their concerns and anxiety related to the event.

Prognosis

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

See Also

• Sudden infant death syndrome
• Gastroesophageal reflux disease
• Seizure disorders
• Respiratory infections

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