New guidelines define brief resolved unexplained events

1. The American Academy of Pediatrics (AAP) has released a clinical practice guideline on brief resolved unexplained events (BRUEs, formerly apparent life-threatening events or ALTEs).

2. This guidelines defines and provides an approach to the treatment of patients following a BRUE through risk stratification and management recommendations.

Clinical Practice Guideline Rundown: This AAP piece stands as the first guideline on BRUEs, a term recommended to replace apparent life-threatening events (ALTEs). A BRUE is defined as an event lasting <1 minute (as characterized by an observer) in which hypotonia, alterations in breathing or skin color, or level of alertness occur in an infant under 1 year of age who then returns to his or her baseline state of health. The event must be unexplained by another medical condition, such as gastroesophageal reflux, swallow dysfunction, infection, child abuse or another cause. The infant must also have a reassuring history and physical examination performed by a medical professional. Infants can be classified as lower-risk if they are older than 60 days, are not premature, do not have a history of previous BRUE, the event is of a short duration (<1 minute), did not require cardiopulmonary resuscitation (CPR) from a trained provider, and had no concerning history or exam features. Extensive management recommendations of varying levels of evidence support are proposed. These include that lower-risk infants may be managed conservatively and should not undergo extensive laboratory testing or home cardiorespiratory monitoring. They may be briefly monitored and undergo ECG and pertussis testing, but do not need to be admitted to the hospital for monitoring. Caregivers of these lower-risk infants should be educated about BRUEs and offered CPR training. The AAP does not provide guidance on higher-risk infants as the current evidence is not sufficient. It does recommend further research using this new, standardized definition for BRUE.

Click to read the clinical practice guideline, published today in Pediatrics

Relevant Reading: Management of apparent life-threatening events in infants: a systematic review

Image: CC/Wiki/Infantcentre

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