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Brief resolved unexplained event: Severity-associated factors at admission in the pediatric emergency ward
Manon Denis1, C Brulé2, B Lauzier3
1Pediatric Intensive Care Unit, CHU de Caen, Caen, F-14000, France; Pediatric Intensive Care Unit, CHU de Nantes, Nantes, F-44000, France; Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000, France.
Insights
Prematurity and prolonged time since last meal are key factors for severe brief resolved unexplained events (BRUE) in infants. Apnea or central hypoventilation was the main severe diagnosis, warranting focused attention on premature infants.
Area of Science:
- Pediatrics
- Neonatology
- Emergency Medicine
Background:
- Brief Resolved Unexplained Event (BRUE) replaced "infant discomfort".
- Identifying infants needing further evaluation for BRUE remains challenging despite current guidelines.
Purpose of the Study:
- To identify factors associated with severe pathology and recurrence in infants presenting with BRUE.
- To analyze the diagnostic yield of routine examinations for BRUE etiology.
Main Methods:
- Retrospective study of 767 pediatric emergency department admissions for BRUE.
- Analysis of 255 patient files to determine factors linked to severe outcomes or recurrence.
Main Results:
- 23 patients (9%) had severe diagnoses; 45 (17.6%) had recurrence.
- Gastroesophageal reflux was common in benign cases; apnea/central hypoventilation in severe cases.
- Prematurity (p=0.032) and time since last meal >1h (p=0.019) were significantly associated with severe disease.
Conclusions:
- Premature infants require focused attention for BRUE due to association with severe diagnoses like apnea/hypoventilation.
- Routine examinations were largely non-contributory to determining BRUE etiology.
- Further prospective research is needed to prioritize diagnostic tests for high-risk infants with BRUE.
Objective:
A brief resolved unexplained event (BRUE) is a recent clinical entity that has now replaced the term "infant discomfort". Despite the availability of recent recommendations, identification of patients requiring further examination remains difficult.
Method:
We aimed to identify factors associated with severe pathology and/or recurrence by studying the medical files of 767 patients admitted to the pediatric emergency department of a French university hospital for a BRUE.
Results:
Overall, 255 files were studied; 45 patients had a recurrence and 23 patients had a severe diagnosis. The most frequently found etiology was gastroesophageal reflux in the benign diagnosis group and apnea or central hypoventilation in the severe diagnosis group. Prematurity (p = 0.032) and time since last meal >1 h (p = 0.019) were the main factors associated with severe disease. Most of the routine examination results remained non-contributive to the etiology.
Conclusion:
As prematurity is a factor associated with severe diagnosis, special attention should be given to this population, without subjecting them to multiple tests, since the main complication was found to be apnea or central hypoventilation. Prospective research is needed to establish the usefulness and prioritization of diagnostic tests for infants who are at "high risk" of experiencing a BRUE.
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