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Brief resolved unexplained event: New diagnosis in infants
Insights
The term apparent life-threatening event (ALTE) has been updated to brief resolved unexplained event (BRUE). This change impacts how infant near-death experiences are evaluated, with a focus on specific symptoms and risk assessment for hospitalization.
Area of Science:
- Pediatrics
- Neonatal Care
- Emergency Medicine
Background:
- The term apparent life-threatening event (ALTE) was previously linked to sudden infant death syndrome (SIDS).
- This led to hospital admissions for infants experiencing acute events.
- Current guidelines recommend updated terminology and diagnostic approaches.
Purpose of the Study:
- To outline the current approach to evaluating infant near-death experiences.
- To introduce the revised terminology and diagnostic criteria for these events.
Main Methods:
- Review of a recent clinical practice guideline.
- Analysis of diagnostic criteria for brief resolved unexplained events (BRUE).
Main Results:
- The definition of ALTE has been revised to brief resolved unexplained event (BRUE).
- BRUE diagnosis in infants <1 year requires a brief, resolved event with specific symptoms (cyanosis, breathing changes, altered responsiveness) unexplained by history/physical exam.
- Low-risk infants with BRUE should not be admitted; overtesting is discouraged.
Conclusions:
- BRUE is the new terminology for ALTE.
- Clinical practice guidelines recommend a focused approach to BRUE diagnosis and management.
- Hospital admission and extensive testing are discouraged for low-risk infants.
Question:
For many years, the term apparent life-threatening event (ALTE) was associated with sudden infant death syndrome, and parents who described an acute event in their infants were sent to the hospital for admission. I understand that for infants new terminology is recommended. What is the current approach to a near-death experience of an infant?
Answer:
A recent clinical practice guideline revised the name and definition of an ALTE to a brief resolved unexplained event (BRUE). The diagnosis of BRUE in infants younger than 1 year of age is made when infants experience 1 of the following BRUE symptoms: a brief episode (ie, less than 1 minute and usually less than 20 to 30 seconds) that is entirely resolved (infant is at baseline), which remains unexplained after the history and physical examination are completed, and includes an event characterized by cyanosis or pallor; absent, decreased, or irregular breathing; hypertonia or hypotonia; or altered responsiveness. Low-risk infants should not be admitted to the hospital and overtesting is discouraged.
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