Brief resolved unexplained events: a new diagnosis, with implications for evaluation and management

Area of Science:

• Pediatrics
• Neonatology
• Emergency Medicine

Background:

• Brief Resolved Unexplained Events (BRUE) are short episodes (<1 min) in infants, characterized by changes in breathing, consciousness, muscle tone, or skin color.
• Previously termed Apparent Life-Threatening Events (ALTE), BRUE was defined by the American Academy of Pediatrics (AAP) in 2016 as a diagnosis of exclusion.
• While often benign, BRUE necessitates consideration of various underlying etiologies, including cardiac, infectious, neurologic, and traumatic conditions.

Purpose of the Study:

• To review the history and definitional changes of BRUE.
• To summarize current AAP guideline recommendations for managing BRUE.
• To highlight future research needs, particularly for higher-risk BRUE events.

Main Methods:

• Review of the literature on BRUE, including its definition, classification, and management.
• Analysis of recent data regarding the incidence of serious diagnoses associated with BRUE.
• Evaluation of the safety and efficacy of current AAP guidelines for lower-risk BRUE.

Main Results:

• BRUE is a diagnosis of exclusion with greater specificity than ALTE.
• Most BRUE cases have a benign course, with serious diagnoses occurring in less than 5% of infants.
• Recent data support the safe implementation of AAP guidelines for lower-risk BRUE infants.

Conclusions:

• BRUE is a more specific diagnosis than previous definitions and is a diagnosis of exclusion.
• Further research is needed for higher-risk BRUE events and their associated risk factors.
• Current AAP guidelines for lower-risk BRUE infants appear safe and effective.