Brief Resolved Unexplained Event

Excerpt

A brief resolved unexplained event (BRUE) is defined by the American Academy of Pediatrics (AAP) as a sudden, brief, and now-resolved episode in an infant younger than 1 year involving 1 or more of the following:

1. Cyanosis or pallor

2. Absent, decreased, or irregular breathing

3. Marked change in tone

4. Altered level of responsiveness

By definition, no explanation is identified after an appropriate history and physical examination. The 2016 AAP clinical practice guideline replaced the former “apparent life-threatening event" (ALTE) terminology and introduced formal risk stratification with evidence-based recommendations for infants meeting lower-risk criteria, which include the following:

1. Age greater than 60 days

2. Gestational age of 32 through 37 weeks, with postconceptional age of at least 45 weeks

3. A first and brief event lasting less than 1 minute

4. Absence of cardiopulmonary resuscitation (CPR) by a trained provider

5. No concerning historical or examination findings.

In accordance with the guideline’s intent to minimize unnecessary interventions, clinicians are advised that avoiding low-value testing and monitoring provides clear benefits. When lower-risk criteria are satisfied, the small chance of missing a rare underlying condition is generally outweighed by these benefits. (Sources: Tieder et al, 2016; Tieder et al, 2019)