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Short article: The endoscopic and histologic findings of infants who have experienced brief resolved unexplained
Chaowapong Jarasvaraparn1, Maria B R Gallegos1, Madhuri S Mulekar2
1Departments of Pediatrics.
Insights
Higher risk brief resolved unexplained events (BRUE) in infants may show rectosigmoid lymphonodular hyperplasia with eosinophilia. Milk soy protein intolerance (MSPI) is a potential cause to consider in BRUE diagnosis.
Area of Science:
- Pediatric Gastroenterology
- Neonatology
- Clinical Pediatrics
Background:
- A brief resolved unexplained event (BRUE) is an episode of change in tone, color, respiration, or responsiveness, unexplained after examination.
- Higher-risk BRUE cases may warrant endoscopic evaluation.
- Infant BRUE evaluations often include gastrointestinal assessments.
Purpose of the Study:
- To identify endoscopic findings in infants with higher-risk BRUE.
- To compare risk factors between infants with and without endoscopic evaluation for BRUE.
- To explore potential associations between BRUE and gastrointestinal conditions.
Main Methods:
- Retrospective descriptive study of infants diagnosed with BRUE (ICD-10 code R68.13).
- Analysis of 23 infants with higher-risk BRUE who underwent esophagogastroduodenoscopy and flexible sigmoidoscopy.
- Comparison with 23 matched infants who did not undergo endoscopy.
Main Results:
- Apnea was the most common BRUE presentation (87%), predominantly in female infants (57%).
- No significant differences in risk factors were found between infants who underwent endoscopy and those who did not.
- The most frequent abnormal endoscopic finding was rectosigmoid lymphonodular hyperplasia (LNH) with eosinophilia, more common in females.
Conclusions:
- Rectosigmoid LNH and eosinophilia, linked to milk soy protein intolerance (MSPI), were common findings.
- While causation is unproven, MSPI should be considered in the differential diagnosis for higher-risk BRUE.
- Endoscopic findings suggest a potential link between MSPI and certain BRUE presentations.
Introduction:
A brief resolved unexplained event (BRUE) describes an event associated with a change in muscle tone, color, respiration, and responsiveness that is unexplained after an appropriate examination. Some infants with higher risk BRUE may undergo endoscopy as part of their evaluation.
Objective:
This retrospective study aimed to identify the endoscopic findings in infants who have experienced a higher risk BRUE. We also compared the characteristics, prenatal, natal, and postnatal risk factors between 23 infants who underwent endoscopic evaluation and 23 race-matched/sex-matched/term-matched/preterm-matched infants who did not undergo endoscopic evaluation.
Methods:
This was a retrospective descriptive study. Infants were identified from a query of medical records using the ICD-10 code for BRUE (R68.13).
Results:
Of 119 infants with BRUE, 23 infants with higher risk BRUE underwent an esophagogastroduodenoscopy and flexible sigmoidoscopy. Apnea (87%) was the most common presentation of BRUE. Most were female (57%) with a mean age at BRUE presentation of 2.73 months. We found 10 (43.5%) term infants and 13 (56.5%) preterm infants in our study. There were no significant differences in characteristics, prenatal, natal, and postnatal risk factors between the infants who underwent endoscopy and those who did not undergo endoscopy. The most common abnormal endoscopic finding was lymphonodular hyperplasia (LNH) associated with eosinophilia in the rectosigmoid colon. The proportion of females in the LNH group was significantly higher than the non-LNH group.
Conclusion:
Rectosigmoid LNH and eosinophilia, which are associated with milk soy protein intolerance (MSPI), were the most common findings on endoscopic evaluation. Although there is no proof of causation between MSPI and BRUE, MSPI should be considered in the differential diagnosis for higher risk BRUE.
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